1
Q
Contained in this deck is ___________________
A
Content: Comfort, Mobility, Inflammation drugs, Anti-infective, Antineoplastic agents
Concepts: Comfort, Mobility, Inflammation
Chapters 24 Neurologic and Neuromuscular Agents
Chapters 25, 26 Anti-inflammatories, Analgesics
Chapters 29, 30, 31 Antibacterial and Anti-infective Agents
Chapters 32, 33, 34 Additional Anti-infective Agents
Chapters 37, 38, 39 Antineoplastic Agents
2
Q
- The nurse is preparing to care for a patient who has myasthenia gravis. The nurse will be alert to symptoms affecting which body system in this patient?
a. Cardiovascular system and postural muscles
b. Central nervous system (CNS), memory, and cognition
c. Gastrointestinal system (GI) and lower extremity muscles
d. Respiratory system and facial muscles
A
ANS: D
d. Respiratory system and facial muscles
Myasthenia gravis causes fatigue and muscular weakness of the respiratory system, facial muscles, and extremities. It does not directly affect the cardiovascular system, CNS, or GI systems.
3
Q
- A 40-year-old woman is diagnosed with myasthenia gravis, and her provider recommends removal of her thymus gland. She asks the nurse why this would be helpful. The nurse will explain that removal of the thymus gland may
a. increase binding of acetylcholine (ACh) molecules to ACh receptors.
b. increase the amount of ACh available at neuromuscular junction sites.
c. reduce the number of acetylcholine receptor sites.
d. reduce the autoimmune destruction of ACh receptor sites.
A
ANS: D
d. reduce the autoimmune destruction of ACh receptor sites.
Myasthenia gravis is an autoimmune disorder involving an antibody response against a subunit of the ACh receptor site. Since the thymus is involved in systemic immunity, it is thought that removing the thymus can inhibit this process. It does not increase binding of ACh molecules to receptors or increase the amount of ACh or reduce the number of ACh receptor sites.
4
Q
- The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of neostigmine (Prostigmin) due 1 hour prior was not given. The nurse will anticipate the patient to exhibit which symptoms?
a. Excessive salivation
b. Muscle spasms
c. Muscle weakness
d. Respiratory paralysis
A
ANS: C
c. Muscle weakness
Neostigmine must be given on time to prevent myasthenic crisis, which is characterized by generalized, severe muscle weakness. The other symptoms are characteristic of cholinergic crisis, caused by too much medication.
5
Q
- The nurse is caring for a patient who has myasthenia gravis (MG) and takes pyridostigmine bromide (Mestinon) 60 mg every 4 hours. The patient’s last dose was 45 minutes prior. The nurse notes severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction. The nurse will perform which action?
a. Assess the patient for signs of ptosis.
b. Notify the provider to discuss an order for intravenous immune globulin (IVIG).
c. Obtain an order for atropine sulfate.
d. Request an order for an extra dose of pyridostigmine.
A
ANS: C
c. Obtain an order for atropine sulfate.
Severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction are the major signs of cholinergic crisis, caused by excess pyridostigmine. The antidote is atropine, so the nurse should obtain an order to give this. Ptosis is sign of myasthenic crisis. IVIG is given to treat symptoms of MG and not used for cholinergic crisis. Giving extra pyridostigmine would increase the symptoms.
6
Q
- The nurse is caring for a patient who has myasthenia gravis (MG) and is receiving pyridostigmine bromide (Mestinon). The nurse notes ptosis of both eyelids and observes that the patient has difficulty swallowing. What action will the nurse perform next?
a. Contact the provider to request an order for atropine sulfate.
b. Contact the provider to request an order for edrophonium chloride (Tensilon).
c. Report signs of cholinergic crisis to the provider.
d. Report signs of myasthenic crisis to the provider.
A
ANS: B
b. Contact the provider to request an order for edrophonium chloride (Tensilon).
Overdosing and underdoing of AChE inhibitors have similar symptoms: muscle weakness, dyspnea, and dysphagia. Edrophonium may be used to diagnose MG or to distinguish between myasthenic crisis and cholinergic crisis since it is a very short-acting AChE inhibitor. When given, if the symptoms are alleviated, the cause is myasthenic crisis; if symptoms worsen, it is cholinergic crisis. Since patients can have similar symptoms, the nurse cannot report one or the other to the provider without more information.
7
Q
- A patient experiences severe muscle weakness, and the provider orders edrophonium bromide (Tensilon). The patient begins to show improved muscle strength within a few minutes after administration of this drug. The nurse anticipates the provider will order which drug?
a. Atropine sulfate
b. Edrophonium bromide (Tensilon)
c. Intravenous immune globulin (IVIG)
d. Pyridostigmine HCl (Mestinon)
A
ANS: D
d. Pyridostigmine HCl (Mestinon)
In this case, edrophonium is used to diagnose myasthenia gravis. Since symptoms improved with the AChE inhibitor, the patient will benefit from a longer-acting AChE inhibitor such as pyridostigmine. Atropine is given for AChE inhibitor overdose. Edrophonium is very short-acting, so it will not be used for treatment. IVIG is used when other AChE inhibitors fail.
8
Q
- A patient exhibits ptosis of both eyes, and the provider orders edrophonium (Tensilon). The nurse notes immediate improvement of the ptosis. The nurse understands that this patient most likely has which disorder?
a. Cerebral palsy
b. Multiple sclerosis
c. Muscle spasms
d. Myasthenia gravis
A
ANS: D
d. Myasthenia gravis
Improvement of symptoms after administration of edrophonium is diagnostic for myasthenia gravis.
9
Q
- The charge nurse observes a nurse administer undiluted intravenous pyridostigmine bromide (Mestinon) at a rate of 0.8 mg/min. The charge nurse will stop the infusion and perform which action?
a. Administer atropine sulfate to prevent cholinergic crisis.
b. Monitor the patient closely for respiratory distress.
c. Suggest that the nurse dilute the medication with colloidal fluids.
d. Tell the nurse to slow the rate of infusion of the pyridostigmine.
A
ANS: D
d. Tell the nurse to slow the rate of infusion of the pyridostigmine.
When given, IV pyridostigmine should be administered undiluted at a rate of 0.5 mg/min and should not be added to IV fluids. It is not necessary to administer atropine, since the patient is not symptomatic of cholinergic crisis.
10
Q
- A patient reports weakness of the extremities and diplopia. The nurse knows that these symptoms are characteristic of which condition?
a. Cerebral palsy (CP)
b. Multiple sclerosis (MS)
c. Myasthenia gravis (MG)
d. Parkinson’s disease (PD)
A
ANS: B
b. Multiple sclerosis (MS)
Diplopia and weakness of the extremities are two symptoms of MS. CP is characterized by muscle spasticity. MG involves generalized weakness, especially of facial muscles and respiratory muscles. PD manifests as tremors and difficulty moving and walking.
11
Q
- A patient has symptoms that are characteristic of multiple sclerosis (MS). Which diagnostic tests are likely to be ordered to aid in the diagnosis of this patient?
a. Cerebrospinal fluid (CSF) immunoglobulin G and magnetic resonance imaging (MRI)
b. CSF proteins and an angiography
c. Serum albumin and a computed tomography (CT) scan
d. Serum anti-acetylcholine antibodies and x-rays
A
ANS: A
a. Cerebrospinal fluid (CSF) immunoglobulin G and magnetic resonance imaging (MRI)
Laboratory tests that may suggest MS include CSF IgG and MRI.
12
Q
- The nurse is caring for a patient who has recurrent muscle spasms. The provider has ordered metaxalone (Skelaxin) to treat the spasms. The nurse learns that the patient has a history of drug and alcohol abuse. The nurse will contact the provider to discuss switching this patient to which medication?
a. Carisoprodol (Soma)
b. Chlorzoxazone (Parafon forte DSC)
c. Cyclobenzaprine (Flexeril)
d. Methocarbamol (Robaxin)
A
ANS: C
c. Cyclobenzaprine (Flexeril)
Cyclobenzaprine is a muscle relaxant that does not cause drug dependence. The other muscle relaxants can cause drug dependence.
13
Q
- The nurse provides teaching to a patient who will begin taking cyclobenzaprine (Flexeril) to treat muscle spasms. Which statement by the patient indicates a need for further teaching?
a. “I may experience dizziness and drowsiness when I take this drug.”
b. “I should not consume alcohol while taking this medication.”
c. “I should take this medication with food to decrease stomach upset.”
d. “I will take this medication for three weeks and then stop taking it.”
A
ANS: D
d. “I will take this medication for three weeks and then stop taking it.”
This medication should not be stopped abruptly. Patients may experience dizziness and drowsiness. Alcohol will compound the central nervous system sedative effects. To decrease gastrointestinal upset, the nurse should counsel the patient to take it with food.
14
Q
- The nurse is performing an admission assessment on a patient who has been taking carisoprodol (Soma) for 3 weeks to treat muscle spasms. The patient reports that the muscle spasms have resolved. The nurse will contact the provider to discuss
a. changing to cyclobenzaprine (Flexeril).
b. continuing the carisoprodol for 1 more week.
c. discontinuing the carisoprodol now.
d. ordering a taper of the carisoprodol.
A
ANS: D
d. ordering a taper of the carisoprodol.
Muscle relaxants can cause drug dependence and should not be withdrawn abruptly. The nurse should discuss a drug taper.
15
Q
- The nurse is teaching a group of nursing students about multiple sclerosis (MS). Which statement by the nurse is correct
a. “MS is characterized by degeneration of neurons and nerves in the brain and spinal cord.”
b. “MS is characterized by lesions or plaques on myelin sheaths of nerves.”
c. “MS is characterized by neuritic plaques and neurofibrillary tangles in the CNS.”
d. “MS is characterized by weak muscles and decreased nerve impulses caused by decreased ACh.”
A
ANS: B
b. “MS is characterized by lesions or plaques on myelin sheaths of nerves.”
MS is characterized by lesions on myelin sheaths of nerves.
16
Q
- The nurse is caring for a patient who has multiple sclerosis. The patient is experiencing an acute attack. Which drug does the nurse anticipate the provider will order?
a. Adrenocorticotropic hormone (ACTH)
b. Cyclophosphamide (Cytoxan)
c. Glatiramer acetate (Copaxone)
d. Interferon-B (IFN-B)
A
ANS: A
a. Adrenocorticotropic hormone (ACTH)
ACTH is given to treat an acute attack of MS. Glatiramer acetate and interferon are used for remission-exacerbation states. Cyclophosphamide is given for chronic, progressive symptoms.
17
Q
- The nurse is performing a health history on a patient who has multiple sclerosis. The patient reports episodes of muscle spasticity and recurrence of muscle weakness and diplopia. The nurse will expect this patient to be taking which medication?
a. Adrenocorticotropic hormone (ACTH)
b. Cyclophosphamide (Cytoxan)
c. Cyclobenzaprine (Flexeril)
d. Interferon-B (IFN-B)
A
ANS: D
d. Interferon-B (IFN-B)
This patient is showing signs of remission and exacerbation of MS symptoms. Interferon is used to treat this phase. ACTH is used for acute attacks. Cyclophosphamide is used for chronic, progressive symptoms. Cyclobenzaprine is a centrally acting muscle relaxant that is used for muscle spasms to decrease pain and increase range of motion.
18
Q
- The nurse is preparing to care for a patient who has multiple sclerosis (MS). The nurse learns that the patient receives cyclophosphamide (Cytoxan). The nurse knows that this patient is in which stage of MS?
a. Acute attack phase
b. Chronic, progressive phase
c. End-stage phase
d. Remission-exacerbation phase
A
ANS: B
b. Chronic, progressive phase
Cyclophosphamide is used to treat MS patients who are in the chronic, progressive phase.
19
Q
- Which muscle relaxant is used in surgery as a skeletal muscle relaxant?
a. Baclofen (Lioresal)
b. Chlorzoxazone (Parafon forte)
c. Pancuronium bromide (Pavulon)
d. Methocarbamol (Robaxin)
A
ANS: C
c. Pancuronium bromide (Pavulon)
Pancuronium bromide is used as a depolarizing muscle relaxant during anesthesia.
20
Q
- The nurse is preparing to administer methocarbamol (Robaxin) to a patient who is experiencing acute muscle spasms. The nurse notes that the patient’s urine has turned black. What will the nurse do?
a. Administer the next dose of methocarbamol since this is a harmless side effect.
b. Contact the provider to discuss changing to cyclobenzaprine (Flexeril).
c. Obtain an order for a complete blood count to evaluate blood loss.
d. Request an order for liver function tests since this indicates hepatotoxicity.
A
ANS: A
a. Administer the next dose of methocarbamol since this is a harmless side effect.
Urine may turn green, brown, or black in patients taking methocarbamol, and this is a harmless side effect. There is no need to change medications or order lab tests.
21
Q
- A client with myasthenia gravis is experiencing a cholinergic crisis. Which symptoms are associated with this condition? (Select all that apply.)
a. Bradycardia
b. Rash
c. Vomiting
d. Fever
e. Drooling
f. Weakness
A
ANS: A, C, E, F
a. Bradycardia
c. Vomiting
e. Drooling
f. Weakness
Bradycardia, drooling, and weakness can all occur with cholinergic crisis.
22
Q
- A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2
a. converts arachidonic acid into a chemical mediator for inflammation.
b. directly causes vasodilation and increased capillary permeability.
c. irritates the gastric mucosa to cause gastrointestinal upset.
d. releases prostaglandins, which cause inflammation and pain in tissues.
A
ANS: A
a. converts arachidonic acid into a chemical mediator for inflammation
COX-2 is an enzyme that converts arachidonic acid into prostaglandins and their products, and this synthesis causes pain and inflammation. They do not act directly to cause inflammation. COX-1 irritates the gastric mucosa. COX-2 synthesizes but does not release prostaglandins.
23
Q
- A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs
a. exert direct actions to cause relaxation of smooth muscle.
b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
c. interfere with neuronal pathways associated with prostaglandin action.
d. suppress prostaglandin activity by blocking tissue receptor sites.
A
ANS: B
b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They do not have direct action on tissues, nor do they interfere with chemical receptor sites or neuronal pathways.
24
Q
- A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take?
a. Counsel the patient to discuss a prescription NSAID with the provider.
b. Recommend adding aspirin to increase the antiinflammatory effect.
c. Suggest asking the provider about a short course of corticosteroids.
d. Tell the patient to increase the dose to 800 mg every 4 hours.
A
ANS: A
a. Counsel the patient to discuss a prescription NSAID with the provider.
The patient should discuss another NSAID with the provider if tolerance has developed to the over-the-counter NSAID. Patients should not take aspirin with NSAIDs because of the increased risk of bleeding and gastrointestinal upset. Steroids are not the drugs of choice for arthritis because of their side effects and are not used unless inflammation is severe. A prescription NSAID would be used prior to starting corticosteroids. Increasing the dose will increase side effects but may not increase desired effects. The maximum dose per day is 2400 mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours.
25
4. A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin
a. increases gastrointestinal secretions.
b. increases hypersensitivity reactions.
c. inhibits both COX-1 and COX-2.
d. is an acidic compound.
ANS: C
c. inhibits both COX-1 and COX-2.
Aspirin is a COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is inhibited, gastric upset occurs. Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions. It is a weak acid.
26
5. A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patient’s provider to discuss changing from aspirin to which drug?
a. A COX-2 inhibitor
b. Celecoxib (Celebrex)
c. Enteric-coated aspirin
d. Nabumetone (Relafen)
ANS: C
c. Enteric-coated aspirin
Aspirin is used to inhibit platelet aggregation to prevent cardiovascular accident and myocardial infarction. Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is responsible for inhibiting platelet aggregation. The patient should take enteric-coated aspirin to lessen the gastrointestinal distress. Celecoxib and nabumetone are both COX-2 inhibitors.
27
6. A patient who is 7 months pregnant and who has arthritis asks the nurse if she can take aspirin for pain. The nurse will tell her not to take aspirin for which reason?
a. It can result in adverse effects on her fetus.
b. It causes an increased risk of Reye’s syndrome.
c. It increases hemorrhage risk.
d. It will cause increased gastrointestinal distress.
ANS: A
a. It can result in adverse effects on her fetus.
Patients should not take aspirin during the third trimester of pregnancy because it can cause premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reye’s syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can cause gastrointestinal distress, but this is not the reason for caution.
28
7. The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication?
a. Aspirin (Bayer)
b. Acetaminophen (Tylenol)
c. Anakinra (Kineret)
d. Prednisone (Deltasone)
ANS: A
a. Aspirin (Bayer)
Aspirin causes tinnitus at low toxicity levels. The nurse should question the patient about this medication. The other medications do not have this side effect.
29
8. The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient?
a. “A normal serum aspirin level is between 30 and 40 mg/dL.”
b. “You may need to stop taking this drug a week prior to surgery.”
c. “You will need to monitor aspirin levels if you are also taking warfarin.”
d. “Your stools may become dark, but this is a harmless side effect.”
ANS: B
b. “You may need to stop taking this drug a week prior to surgery.”
Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time. A normal serum level is 15 to 30 mg/dL. Patients taking warfarin and aspirin will have increased amounts of warfarin, so the INR will need to be monitored. Tarry stools are a symptom of gastrointestinal bleeding and should be reported.
30
9. A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action?
a. Assess the patient for tinnitus.
b. Monitor the patient for signs of Reye’s syndrome.
c. Notify the provider of severe aspirin toxicity.
d. Request an order for an increased aspirin dose.
ANS: A
a. Assess the patient for tinnitus.
Mild toxicity occurs at levels above 30 mg/dL, so the nurse should assess for signs of toxicity, such as tinnitus. This level will not increase the risk for Reye’s syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased.
31
10. The nurse provides teaching for a patient who will begin taking indomethacin (Indocin) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching?
a. “I should limit sodium intake while taking this drug.”
b. “I should take indomethacin on an empty stomach.”
c. “I will need to check my blood pressure frequently.”
d. “I will take the medication twice daily.”
ANS: B
b. “I should take indomethacin on an empty stomach.”
Indomethacin is very irritating to the stomach and should be taken with food. It can cause sodium retention and elevated blood pressure, so patients should limit sodium intake. The medication is taken twice daily.
32
11. The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication?
a. Diclofenac sodium (Voltaren)
b. Ketoprofen (Orudis)
c. Ketorolac (Toradol)
d. Naproxyn (Naprosyn)
ANS: C
c. Ketorolac (Toradol)
Ketorolac is the first injectable NSAID and has shown analgesic efficacy equal or superior to that of opioid analgesics. The other NSAIDs listed are not used for postoperative pain.
33
12. A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking over-the-counter ibuprofen (Motrin). What will the nurse tell this patient?
a. “It may take several weeks to achieve therapeutic effects.”
b. “Unlike aspirin, there is no increased risk of bleeding with ibuprofen.”
c. “Take ibuprofen twice daily for maximum analgesic benefit.”
d. “Combine ibuprofen with acetaminophen for best effect.”
ANS: A
a. “It may take several weeks to achieve therapeutic effects.”
OTC NSAIDs can be effective for mild to moderate arthritis pain, but the effects may not appear for several weeks. NSAIDs carry a risk for bleeding. Ibuprofen is taken every 4 hours or QID. Ibuprofen should not be combined with aspirin or acetaminophen.
34
13. The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action?
a. Assess the patient for drug-seeking behaviors.
b. Notify the provider that the drug is not effective.
c. Reassure the patient that swelling will decrease eventually.
d. Remind the patient that this drug is given for pain only.
ANS: B
b. Notify the provider that the drug is not effective.
This medication is effective for both pain and swelling. After 4 weeks, there should be some decrease in swelling, so the nurse should report that this medication is ineffective. There is no indication that this patient is seeking an opioid analgesic. The drug should be effective within several weeks. NSAIDs are given for pain and swelling.
35
14. The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What information will the nurse include in teaching?
a. “Do not take the medication during the first 2 days of your period.”
b. “The initial dose will be twice the amount of subsequent doses.”
c. “Take this medication with food to minimize gastrointestinal upset.”
d. “Take the drug on a regular basis to prevent dysmenorrhea.”
ANS: B
b. “The initial dose will be twice the amount of subsequent doses.”
The initial dose of Celebrex is twice that of subsequent doses. The medication should not be taken just before a period. It does not need to be taken with food. It is taken as needed.
36
15. The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need?
a. Calcium level
b. Complete blood count
c. Electrolytes
d. Potassium
ANS: B
b. Complete blood count
Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation.
37
16. The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug?
a. Avoid all alcohol except beer.
b. Include salmon in the diet.
c. Increase fluid intake.
d. Take on an empty stomach
ANS: C
c. Increase fluid intake.
The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi. Foods rich in purine should be avoided, including beer, and some sea foods, such as salmon. Gastric irritation is a common problem, so colchicine should be taken with food.
38
17. Which antigout medication is used to treat chronic tophaceous gout?
a. Allopurinol (Zyloprim)
b. Colchicine
c. Probenecid (Benemid)
d. Sulfinpyrazone (Anturane)
ANS: A
a. Allopurinol (Zyloprim)
Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout. Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout. Probenecid can be used for chronic gout but is not the first choice. Sulfinpyrazone has many serious side effects.
39
18. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patient’s medical record and will be concerned about which laboratory result?
a. Elevated BUN and creatinine
b. Increased serum uric acid
c. Slight increase in the white blood count
d. Increased serum glucose
ANS: A
a. Elevated BUN and creatinine
Antigout drugs are excreted via the kidneys, so patients should have adequate renal function.
40
19. The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching?
a. “I should increase my vitamin C intake.”
b. “I will get yearly eye exams.”
c. “I will increase my protein intake.”
d. “I will limit fluids to prevent edema.”
ANS: B
b. “I will get yearly eye exams.”
Patients taking allopurinol can have visual changes with prolonged use and should have yearly eye exams. It is not necessary to increase vitamin C. Protein can increase purine intake, which is not recommended. Patients should consume extra fluids.
41
1. Which are characteristic signs of inflammation? (Select all that apply.)
a. Edema
b. Erythema
c. Heat
d. Numbness
e. Pallor
f. Paresthesia
ANS: A, B, C
a. Edema
b. Erythema
c. Heat
Edema, erythema, and heat are signs of inflammation. The other three are signs of neurocirculatory compromise
42
2. The nurse is teaching a female patient who will begin taking 2 tablets of 325 mg acetaminophen every 4 to 6 hours as needed for pain. Which statement by the patient indicates understanding of the teaching?
a. “I may take acetaminophen up to 6 times daily if needed.”
b. “I should increase the dose of acetaminophen if I drink caffeinated coffee.”
c. “If I take oral contraceptive pills, I should use back-up contraception.”
d. “It is safe to take acetaminophen with any over-the-counter medications.”
ANS: A
a. “I may take acetaminophen up to 6 times daily if needed.”
The maximum daily dose of acetaminophen is 4000 mg. If this patient takes 650 mg/dose 6 times daily, this amount is safe. Taking acetaminophen with caffeine increases the effect of the acetaminophen. Taking acetaminophen with OCPs decreases the effect of the acetaminophen but does not diminish the effect of the OCP. Many over-the-counter medications contain acetaminophen, so patients should be advised to read labels carefully to avoid overdose.
43
3. The parent of a 5-year-old child asks the nurse to recommend an over-the-counter pain medication for the child. Which analgesic will the nurse recommend?
a. Acetaminophen (Tylenol)
b. Aspirin (Ecotrin)
c. Diflunisal (Dolobid)
d. Ibuprofen (Motrin)
ANS: A
a. Acetaminophen (Tylenol)
Acetaminophen is safe to give children and does not cause gastrointestinal upset or interfere with platelet aggregation. Aspirin carries an increased risk of Reye’s syndrome in children. Diflunisal (Dolobid) is not available over the counter.
44
4. The nurse is performing an admission assessment on an adolescent who reports taking extra-strength acetaminophen (Tylenol) regularly to treat daily headaches. The nurse will notify the patient’s provider and discuss an order for
a. a selective serotonin receptor agonist (SSRA).
b. hydrocodone with acetaminophen for headache pain.
c. liver enzyme tests.
d. serum glucose testing.
ANS: C
c. liver enzyme tests.
Large doses or overdoses of acetaminophen can be toxic to hepatic cells, so when large doses are administered over a long period, liver function should be assessed. Daily headaches are not typical of migraine headaches, so SSRA medication is not indicated. Hydrocodone with acetaminophen is not indicated without further evaluation of headaches. Serum glucose is not indicated.
45
5. The nurse is caring for a postoperative older patient who received PO hydrocodone with acetaminophen (Lortab) 45 minutes prior after reporting a pain level of 8 on a scale of 1 to 10. The patient reports a pain level of 4, and the nurse notes a respiratory rate of 20 breaths per minute, a heart rate of 92 beats per minute, and a blood pressure of 170/95 mm Hg. Which action will the nurse take?
a. Contact the provider and request an order for a more potent opioid analgesic.
b. Reassess the patient in 30 minutes.
c. Request an order for ibuprofen to augment the opioid analgesic.
d. Suggest that the patient use nonpharmacologic measures to relieve pain.
ANS: A
a. Contact the provider and request an order for a more potent opioid analgesic.
Even though the patient reports decreased pain, the patient’s vital signs indicate continued discomfort. The nurse should contact the provider to request a stronger analgesic. The pain medication should have been effective within 30 minutes. Ibuprofen is used for musculoskeletal pain. Nonpharmacologic measures may be useful, but the patient still needs a stronger analgesic.
46
6. The nurse is providing teaching to a patient who will begin taking aspirin to treat arthritis pain. Which statement by the patient indicates a need for further teaching?
a. “I should increase fiber and fluids while taking aspirin.”
b. “I will call my provider if I have abdominal pain.”
c. “I will drink a full glass of water with each dose.”
d. “I will notify my provider of ringing in my ears.”
ANS: A
a. “I should increase fiber and fluids while taking aspirin.”
Aspirin is not constipating, so patients do not need to be counseled to consume extra fluids and fiber. Abdominal pain can occur with gastrointestinal bleeding, and tinnitus (ringing in the ears) can be an early sign of toxicity, so patients should be taught to contact their provider if these occur. Taking a full glass of water with each dose helps minimize gastrointestinal side effects.
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7. An adolescent female has dysmenorrhea associated with heavy menstrual periods. The patient’s provider has recommended ibuprofen (Motrin). When teaching this patient about this drug, the nurse will tell her that ibuprofen
a. may decrease the effectiveness of oral contraceptive pills.
b. may increase bleeding during her period.
c. should be taken on an empty stomach to increase absorption.
d. will decrease the duration of her periods.
ANS: B
b. may increase bleeding during her period.
When nonsteroidal antiinflammatory drugs (NSAIDs) are used to treat dysmenorrhea, excess bleeding may occur during the first 2 days of a period. NSAIDs do not decrease the effect of OCPs. NSAIDs are irritating to the stomach, so patients should take with food or a full glass of water. NSAIDs will not decrease the duration of periods.
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8. The emergency department nurse is caring for a patient who has received morphine sulfate for severe pain following an injury. The nurse performs a drug history and learns that the patient takes St. John’s wort for symptoms of depression. The nurse will observe this patient closely for an increase in which opioid adverse effect?
a. Constipation
b. Pruritis
c. Respiratory depression
d. Sedation
ANS: D
d. Sedation
St. John’s wort can increase the sedative effects of opioids. It does not enhance other side effects.
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9. The nurse is performing an admission assessment on a stable patient admitted after a motor vehicle accident. The patient reports having “bad pain.” What will the nurse do first?
a. Administer acetaminophen (Tylenol).
b. Ask the patient to rate the pain on a 1 to 10 scale.
c. Attempt to determine what type of pain the patient has.
d. Request an order for an intravenous opioid analgesic.
ANS: B
b. Ask the patient to rate the pain on a 1 to 10 scale.
To ascertain severity of pain, the nurse should ask the patient to rate the pain on a scale of 1 to 10. Further assessments include location and type of pain. Pain medication should be given after the severity of pain is assessed so that an appropriate analgesic may be given.
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10. The nurse assumes care of a patient in the post-anesthesia care unit (PACU). The patient had abdominal surgery and is receiving intravenous morphine sulfate for pain. The patient is asleep and has not voided since prior to surgery. The nurse assesses a respiratory rate of 10 breaths per minute and notes hypoactive bowel sounds. The nurse will contact the surgeon to report which condition?
a. Paralytic ileus
b. Respiratory depression
c. Somnolence
d. Urinary retention
ANS: B
b. Respiratory depression
The patient’s respiratory rate of 10 breaths per minute is lower than normal and is a sign of respiratory depression, which is a common adverse effect of opioid analgesics. The other effects may occur with opioids but are also not expected this soon after abdominal surgery.
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11. One hour after receiving intravenous morphine sulfate, a patient reports generalized itching. The nurse assesses the patient and notes clear breath sounds, no rash, respirations of 14 breaths per minute, a heart rate of 68 beats per minute, and a blood pressure of 110/70 mm Hg. Which action will the nurse take?
a. Administer naloxone to reverse opiate overdose.
b. Have resuscitation equipment available at the bedside.
c. Prepare an epinephrine injection in case of an anaphylactic reaction.
d. Reassure the patient that this is a common side effect of this drug.
ANS: D
d. Reassure the patient that this is a common side effect of this drug.
Pruritis is a common opioid side effect and can be managed with diphenhydramine. Patients developing anaphylaxis will have urticaria and hypotension, and these patients will need epinephrine and resuscitation. Respiratory depression is a sign of morphine overdose, which will require naloxone.
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12. The nurse administers nalbuphine (Nubain) to a patient who is experiencing severe pain. Which statement by the patient indicates a need for further teaching about this drug?
a. “I may experience unusual dreams while taking this medication.”
b. “I may need to use a laxative when taking this drug.”
c. “I should ask for assistance when I get out of bed.”
d. “I should expect to have more frequent urination.”
ANS: D
d. “I should expect to have more frequent urination.”
A common side effect of opioid agents is urinary retention. Patients should notify the nurse if they cannot void. Side effects may include unusual dreams, constipation, and dizziness.
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13. The nurse is caring for a patient who was admitted with a fractured leg and for observation of a closed head injury after a motor vehicle accident. The patient reports having pain at a level of 3 on a 1 to 10 pain scale. The nurse will expect the provider to order which analgesic medication for this patient?
a. Acetaminophen (Tylenol) PO
b. Hydromorphone HCl (Dilaudid) IM
c. Morphine sulfate PCA
d. Transdermal fentanyl (Duragesic)
ANS: A
a. Acetaminophen (Tylenol) PO
Use of opioid analgesics is contraindicated for patients with head injuries because of the risk of increased intracranial pressure. If opioids are necessary because of severe pain, they must be given in reduced doses. This patient is experiencing mild pain, so acetaminophen is an appropriate analgesic.
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14. Which patient may require a higher than expected dose of an opioid analgesic?
a. A patient with cancer
b. A patient with a concussion
c. A patient with hypotension
d. A patient 3 days after surgery
ANS: A
a. A patient with cancer
Opioids are titrated for oncology patients until pain relief is achieved or the side effects become intolerable, and extremely high doses may be required. Patient with closed head injuries should receive reduced doses of opioids if at all to reduce the risk of increased intracranial pressure. Patients with hypotension should receive reduced doses to prevent further decrease in blood pressure. Patients who are 3 days post-operation should not be experiencing severe pain.
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15. The nurse assesses an older patient 60 minutes after administering 4 mg of intravenous morphine sulfate (MS) for postoperative pain. The patient’s analgesia order is for 2 to 5 mg of MS IV every 2 hours. The nurse notes that the patient is lying very still. The patient’s heart rate is 96 beats per minute, respiratory rate is 14 breaths per minute, and blood pressure is 140/90 mm Hg. When asked to rate the level of pain, the patient replies “just a 5.” The nurse will perform which action?
a. Give 3 mg of MS at the next dose.
b. Give 5 mg of MS at the next dose.
c. Request an order for an oral opioid to give now.
d. Request an order for acetaminophen to give now.
ANS: B
b. Give 5 mg of MS at the next dose.
Older patients often minimize pain when asked, so the nurse should evaluate nonverbal cues to pain such as elevated heart rate and blood pressure and the fact that the patient is lying very still. The nurse should increase the dose the next time the pain medication is given.
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16. A postoperative patient has a history of opioid abuse. Which analgesic medication will the nurse expect the provider to order for this patient?
a. Buprenorphine (Buprenex)
b. Butorphanol tartrate (Stadol)
c. Naloxone (Narcan)
d. Pentazocine (Talwin)
ANS: A
a. Buprenorphine (Buprenex)
Buprenorphine is an opioid agonist-antagonist analgesic and was developed to help decrease opioid abuse. Butophanol and pentazocine are also in this class, but reports say that they cause dependence. Naloxone is an opioid antagonist and is given to reverse the effects of opioids if toxicity occurs.
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17. The nurse checks on a patient who has received sumatriptan (Imitrex) for treatment of a migraine headache. The patient reports moderate improvement in headache pain and reports feeling dizzy. The nurse notes a blood pressure of 160/85 mm Hg. Which action by the nurse is correct?
a. Notify the provider of the dizziness.
b. Notify the provider of the increased blood pressure.
c. Plan to administer a second dose in 1 hour.
d. Request an order for intranasal sumatriptan.
ANS: B
b. Notify the provider of the increased blood pressure.
Triptans can cause increased blood pressure, which is an adverse drug reaction and should be reported to the provider. Dizziness is a common side effect but not potentially life-threatening. The second dose should not be given if the patient is experiencing elevated blood pressure. Intranasal sumatriptan has the same adverse effects.
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18. The nurse is caring for a 6-year-old child who had surgery that morning. The child is awake and lying very still in bed and won’t respond when the nurse asks about pain. The nurse will perform which action?
a. Ask the child to rate the pain on a scale of 1 to 10.
b. Encourage the child to request pain medication when needed.
c. Evaluate the child’s pain using an “ouch” scale.
d. Plan to administer pain medication if the child begins to cry.
ANS: C
c. Evaluate the child’s pain using an “ouch” scale.
Some children will not verbalize discomfort even when they have severe pain because they fear injections. Nurses may use an “ouch” scale or a faces scale to evaluate pain if the child won’t respond. Waiting for severe pain is not appropriate
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1. The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs?
a. Drugs with a broad spectrum
b. Drugs with a narrow spectrum
c. Drugs with a broad therapeutic index
d. Drugs with a narrow therapeutic index
ANS: D
d. Drugs with a narrow therapeutic index
Medications with a narrow therapeutic index have a limited range between the therapeutic dose and a toxic dose. It is important to monitor these medications closely by evaluating regular serum peak and trough levels.
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2. The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 mcg/mL to 2.2 mcg/mL. What will the nurse expect the patient to experience?
a. Inadequate drug effects
b. Increased risk for superinfection
c. Minimal adverse effects
d. Slowed onset of action
ANS: A
a. Inadequate drug effects
Low peak levels may indicate that the medication is below the therapeutic level. They do not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset of action.
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3. The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept?
a. “A serum drug level greater than the MEC ensures that the drug is bacteriostatic.”
b. “A serum drug level greater than the MEC broadens the spectrum of the drug.”
c. “A serum drug level greater than the MEC helps eradicate bacterial infections.”
d. “A serum drug level greater than the MEC increases the therapeutic index.”
ANS: C
c. “A serum drug level greater than the MEC helps eradicate bacterial infections.”
The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the spectrum or increase the therapeutic index of a drug.
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4. The nurse is caring for a patient who has recurrent urinary tract infections. The patient’s current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to
a. acquired bacterial resistance.
b. cross-resistance.
c. inherent bacterial resistance.
d. transferred resistance.
ANS: A
a. acquired bacterial resistance.
Acquired resistance occurs when an organism has been exposed to the antibacterial drug. Cross-resistance occurs when an organism that is resistant to one drug is also resistant to another. Inherent resistance occurs without previous exposure to the drug. Transferred resistance occurs when the resistant genes of one organism are passed to another organism.
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5. The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take?
a. Administer the amoxicillin and have epinephrine available.
b. Ask the provider to order an antihistamine.
c. Contact the provider to discuss using a different antibiotic.
d. Request an order for a beta-lactamase resistant drug.
ANS: C
c. Contact the provider to discuss using a different antibiotic.
Patients who have previously experienced manifestations of allergy to a penicillin should not use penicillins again unless necessary. The nurse should contact the provider to discuss using another antibiotic from a different class. Epinephrine and antihistamines are useful when patients are experiencing allergic reactions, depending on severity.
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6. The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39° C. What is the nurse’s next action?
a. Administer the antibiotic as ordered.
b. Contact the provider to request another culture.
c. Discuss the need to add a second antibiotic with the provider.
d. Review the sensitivity results from the patient’s culture.
ANS: D
d. Review the sensitivity results from the patient’s culture.
The sensitivity results from the patient’s culture will reveal whether the organism is sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic being given, so the antibiotic should be held and the provider notified. Another culture is not indicated. Antibiotics should be added only when indicated by the sensitivity.
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7. The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic?
a. Administering a small test dose to determine whether hypersensitivity exists
b. Having epinephrine available in the event of a severe hypersensitivity reaction
c. Monitoring baseline vital signs, including temperature and blood pressure
d. Obtaining a specimen for culture and sensitivity
ANS: D
d. Obtaining a specimen for culture and sensitivity
To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins. It is important to obtain cultures when possible in order to correctly identify the organism and help determine which antibiotic will be most effective. Administering test doses to determine hypersensitivity is sometimes done when there is a strong suspicion of allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there is a strong suspicion of allergy.
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8. A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patient’s provider to order
a. a broad-spectrum antibiotic.
b. a narrow-spectrum antibiotic.
c. multiple antibiotics.
d. the pneumococcal vaccine.
ANS: A
a. a broad-spectrum antibiotic.
Broad-spectrum antibiotics are frequently used to treat infections when the offending organism has not been identified by culture and sensitivity (C&S). Narrow-spectrum antibiotics are usually effective against one type of organism and are used when the C&S indicates sensitivity to that antibiotic. The use of multiple antibiotics, unless indicated by C&S, can increase resistance. The pneumococcal vaccine is used to prevent, not treat, an infection.
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9. The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct?
a. “Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved.”
b. “If diarrhea occurs, stop taking the drug immediately and contact your provider.”
c. “Stop taking the drug and notify your provider if you develop a rash while taking this drug.”
d. “You may save any unused antibiotic to use if your symptoms recur.”
ANS: C
c. “Stop taking the drug and notify your provider if you develop a rash while taking this drug.”
Patients who develop signs of allergy, such as rash, should notify their provider before continuing medication therapy. Patients should be counseled to continue taking their antibiotics until completion of the prescribed regimen even when they feel well. Diarrhea is an adverse effect but does not warrant cessation of the drug. Before deciding to stop taking a medication due to a side effect, encourage the patient to contact the provider first. Patients should discard any unused antibiotic.
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10. The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patient’s chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurse’s next action?
a. Administer the drug and observe closely for hypersensitivity reactions.
b. Ask the provider whether a cephalosporin from a different generation may be used.
c. Contact the provider to report drug hypersensitivity.
d. Notify the provider and suggest an oral cephalosporin.
ANS: A
a. Administer the drug and observe closely for hypersensitivity reactions.
A small percentage of patients who are allergic to penicillin could also be allergic to a cephalosporin product. Patients should be monitored closely after receiving a cephalosporin if they are allergic to penicillin. There is no difference in hypersensitivity potential between different generations or method of delivery of cephalosporins.
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11. The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patient’s tongue and buccal mucosa. Which action will the nurse take?
a. Hold the drug and notify the provider.
b. Obtain an order to culture the oral lesions.
c. Gather emergency equipment to prepare for anaphylaxis.
d. Report a possible superinfection side effect of the cephalosporin.
ANS: D
d. Report a possible superinfection side effect of the cephalosporin.
The patient’s symptoms may indicate a superinfection and should be reported to the physician so it can be treated; however, the drug does not need to be held. It is not necessary to culture the lesions. The symptoms do not indicate impending anaphylaxis.
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12. The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching?
a. “I may stop taking the medication if my symptoms clear up.”
b. “I should eat yogurt while taking this medication.”
c. “I should stop taking the drug and call my provider if I develop a rash.”
d. “I will not consume alcohol while taking this medication.”
ANS: A
a. “I may stop taking the medication if my symptoms clear up.”
Patients should take all of an antibiotic regimen even after symptoms clear to ensure complete treatment of the infection. Patients are often advised to eat yogurt or drink buttermilk to prevent superinfection. A rash is a sign of hypersensitivity, and patients should be counseled to stop taking the drug and notify the provider if this occurs. Alcohol consumption may cause adverse effects and should be avoided by patients while they are taking cephalosporins.
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13. The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect?
a. Decreased effectiveness of cefaclor.
b. Increased effectiveness of cefaclor.
c. Decreased effectiveness of erythromycin.
d. Increased effectiveness of erythromycin.
ANS: A
a. Decreased effectiveness of cefaclor.
The interaction of cefaclor and erythromycin will produce a decrease in the action of the cefaclor.
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14. A patient is receiving high doses of a cephalosporin. Which laboratory values will this patient’s nurse monitor closely?
a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests
b. Complete blood count and electrolytes
c. Serum calcium and magnesium
d. Serum glucose and lipids
ANS: A
a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests
Cefazolin will produce an increase in the patient’s BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin.
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15. A patient will begin taking amoxicillin. The nurse should instruct the patient to avoid which foods?
a. Green leafy vegetables
b. Beef and other red meat
c. Coffee, tea, and colas
d. Acidic fruits and juices
ANS: D
d. Acidic fruits and juices
Acidic fruits and juices should be avoided while the client is being treated with amoxicillin because amoxicillin can be irritating to the stomach. Stomach irritation will be increased with the ingestion of citrus and acidic foods. Amoxicillin may also be less effective when taken with acidic fruit or juice.
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16. The patient will begin taking penicillin G procaine (Wycillin).The nurse notes that the solution is milky in color. What action will the nurse take?
a. Call the pharmacist and report the milky color.
b. Add normal saline to dilute the medication.
c. Call the physician and report the milky appearance.
d. Administer the medication as ordered by the physician.
ANS: D
d. Administer the medication as ordered by the physician.
Penicillin G procaine (Wycillin) has a milky appearance; therefore, the appearance should not concern the nurse.
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1. Which actions can contribute to bacterial resistance to antibiotics? (Select all that apply.)
a. Frequent use of antibiotics
b. Giving large doses of antibiotics
c. Skipping doses
d. Taking a full course of antibiotics
e. Treating viral infections with antibiotics
ANS: A, C, E
a. Frequent use of antibiotics
c. Skipping doses
e. Treating viral infections with antibiotics
Frequent use of antibiotics increases the exposure of bacteria to an antibiotic and results in acquired resistance. Skipping doses of an antibiotic can lead to incomplete treatment of an infection, and the remaining bacteria may develop acquired resistance. Treating viral infections with antibiotics is unnecessary and may cause acquired resistance to develop from unneeded exposure to a drug. Infections adequately treated with an antibiotic do not result in resistance.
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1. The nurse caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The nurse will contact the provider to
a. discuss giving a smaller dose of penicillin.
b. discuss using erythromycin (E-mycin) instead of penicillin.
c. request an order for diphenhydramine (Benadryl).
d. suggest that the patient receive cefuroxime (Ceftin).
ANS: B
b. discuss using erythromycin (E-mycin) instead of penicillin.
Erythromycin is the drug of choice when penicillin is not an option. Giving smaller doses of penicillin does not prevent hypersensitivity reactions. Benadryl is useful when a hypersensitivity reaction has occurred. A small percentage of patients allergic to penicillins may be hypersensitive to cephalosporins.
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2. A patient is diagnosed with mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection?
a. Azithromycin (Zithromax)
b. Clarithromycin (Biaxin)
c. Erythromycin (E-Mycin)
d. Fidaxomicin (Dificid)
ANS: C
c. Erythromycin (E-Mycin)
Erythromycin is the drug of choice for treating mycoplasma pneumonia.
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3. The nurse is caring for several patients who are receiving antibiotics. Which order will the nurse question?
a. Azithromycin (Zithromax) 500 mg IV in 500 mL fluid
b. Azithromycin (Zithromax) 500 mg PO once daily
c. Erythromycin 300 mg IM QID
d. Erythromycin 300 mg PO QID
ANS: C
c. Erythromycin 300 mg IM QID
Erythromycin and other macrolides should not be given intramuscularly because they cause painful tissue irritation.
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4. The nurse is caring for a patient who is receiving a high dose of intravenous azithromycin to treat an infection. The patient is also taking acetaminophen for pain. The nurse should expect to review which lab values when monitoring for this drug’s side effects?
a. Complete blood counts
b. Electrolytes
c. Liver enzymes
d. Urinalysis
ANS: C
c. Liver enzymes
High doses of macrolides, when taken with other, potentially hepatotoxic drugs such as acetaminophen may cause hepatotoxicity, so liver enzymes should be carefully monitored.
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5. The nurse provides home care instructions for a patient who will take a high dose of azithromycin after discharge from the hospital. Which statement by the patient indicates understanding of the teaching?
a. “I may take antacids 2 hours before taking this drug.”
b. “I should take acetaminophen for fever or mild pain.”
c. “I should expect diarrhea to be a common, mild side effect.”
d. “I should avoid dairy products while taking this drug.”
ANS: A
a. “I may take antacids 2 hours before taking this drug.”
Azithromycin peak levels may be reduced by antacids when taken at the same time so patients should be cautioned to take antacids 2 hours before or 2 hours after taking the drug. High-dose azithromycin carries a risk for hepatotoxicity when taken with other potentially hepatotoxic drugs such as acetaminophen. Diarrhea may indicate pseudomembranous colitis and should be reported. There is no restriction for dairy products when taking azithromycin.
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6. The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action?
a. Ask the provider if azithromycin may be used instead of clarithromycin.
b. Obtain an order for continuous cardiovascular monitoring.
c. Request an order for periodic serum warfarin levels.
d. Withhold the clarithromycin and notify the provider.
ANS: C
c. Request an order for periodic serum warfarin levels.
Macrolides can increase serum levels of other drugs such as warfarin. If these drugs are used with macrolides, serum drug levels should be monitored. All macrolides have this drug interaction. Cardiovascular monitoring is not indicated. The drug may be given as long as serum drug levels are monitored.
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7. A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide order would the nurse question for this patient?
a. Azithromycin (Zithromax)
b. Clarithromycin (Biaxin)
c. Erythromycin (E-Mycin)
d. Fidaxomicin (Dificid)
ANS: C
c. Erythromycin (E-Mycin)
When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase.
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8. The nurse is preparing to give a dose of oral clindamycin (Cleocin) to a patient who is being treated for a skin infection caused by Staphylococcus aureus. The patient has had several doses of the medication and reports having nausea. Which action will the nurse take next?
a. Administer the next dose when the patient has an empty stomach.
b. Hold the next dose and contact the patient’s provider.
c. Instruct the patient to take the next dose with a full glass of water.
d. Request an order for an antacid to give along with the next dose.
ANS: C
c. Instruct the patient to take the next dose with a full glass of water.
Clindamycin should be taken with a full glass of water to minimize gastronintestinal (GI) irritation such as nausea, vomiting, and stomatitis. Giving the medication on an empty stomach will increase the likelihood of GI upset. It is not necessary to hold the next dose or to give an antacid.
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9. The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patient’s face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take?
a. Request an order for IV epinephrine to treat anaphylactic shock.
b. Slow the infusion to 10 mg/min and observe the patient closely.
c. Stop the infusion and obtain an order for a BUN and serum creatinine.
d. Suspect Stevens-Johnson syndrome and notify the provider immediately.
ANS: B
b. Slow the infusion to 10 mg/min and observe the patient closely.
When vancomycin is infused too rapidly, “red man” syndrome may occur; the rate should be 10 mg/min to prevent this. This is a toxic reaction, not an allergic one, so epinephrine is not indicated. Stevens-Johnson syndrome is characterized by a rash and fever. Red man syndrome is not related to renal function.
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10. The nurse is caring for a patient who will begin taking doxycycline to treat an infection. The nurse should plan to give this medication
a. 1 hour before or 2 hours after a meal.
b. with an antacid to minimize GI irritation.
c. with food to improve absorption.
d. with small sips of water.
ANS: C
c. with food to improve absorption.
Doxycycline is a lipid-soluble tetracycline and is better absorbed when taken with milk products and food. It should not be taken on an empty stomach. Antacids impair absorption of tetracyclines. Small sips of water are not necessarily indicated.
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11. The nurse is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the nurse question for this patient?
a. Azithromycin (Zithromax)
b. Clarithromycin (Biaxin)
c. Clindamycin (Cleocin)
d. Tetracycline (Sumycin)
ANS: D
d. Tetracycline (Sumycin)
Tetracyclines should not be given to children younger than 8 years of age because they irreversibly discolor the permanent teeth.
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12. The nurse is caring for a patient who is receiving a high dose of tetracycline (Sumycin). Which laboratory values will the nurse expect to monitor while caring for this patient?
a. Blood urea nitrogen (BUN) and creatinine levels
b. Complete blood counts
c. Electrolytes
d. Liver enzyme levels
ANS: A
a. Blood urea nitrogen (BUN) and creatinine levels
High doses of tetracyclines can lead to nephrotoxicity, especially when given along with other nephrotoxic drugs. Renal function tests should be performed to monitor for nephrotoxicity.
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13. A female patient will receive doxycycline to treat a sexually transmitted illness (STI). What information will the nurse include when teaching this patient about this medication?
a. Nausea and vomiting are uncommon adverse effects.
b. The drug may cause possible teratogenic effects.
c. Increase intake of dairy products with each dose of this medication.
d. Use a backup method of contraception if taking oral contraceptives.
ANS: D
d. Use a backup method of contraception if taking oral contraceptives.
The desired action of oral contraceptives can be lessened when taken with tetracyclines, so patients taking oral contraceptives should be advised to use a backup contraception method while taking tetracyclines. Nausea and vomiting are common adverse effects. Doxycycline should not be taken with dairy products. Tetracycline may cause teratogenic effects.
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14. The nurse is preparing to administer intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action?
a. Administer the medication and give the infant extra oral fluids.
b. Contact the provider to request adding intravenous fluids when giving the medication.
c. Give the medication and obtain a serum peak drug level 45 minutes after the dose.
d. Hold the dose and contact the provider to request a serum trough drug level.
ANS: D
d. Hold the dose and contact the provider to request a serum trough drug level.
Gentamicin can cause nephrotoxicity. When changes in urine output occur, the provider should be notified, and serum trough levels should be obtained to make sure the drug is not at a toxic level. If the drug level is determined to be safe, giving extra fluids either orally or intravenously may be indicated. Serum peak levels give information about therapeutic levels but are not a substitution for avoiding nephrotoxicity in the face of possible oliguria.
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15. The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss
a. decreasing the dose to 50 mg QID.
b. giving the dose 3 times daily.
c. obtaining a serum drug level.
d. ordering a hearing test.
ANS: C
c. obtaining a serum drug level.
Aminoglycosides can cause ototoxicity. Any changes in hearing should be reported to the provider so that serum drug levels can be monitored. The dose is correct for this patient’s weight (5 mg/kg/day in 4 divided doses). A hearing test is not indicated unless changes in hearing persist.
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16. The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action?
a. Administer each antibiotic to infuse over 15 to 20 minutes.
b. Order serum peak and trough levels of ampicillin.
c. Prepare the schedule so that the drugs are given at the same time.
d. Set up separate tubing sets for each drug labeled with the drug name and date.
ANS: D
d. Set up separate tubing sets for each drug labeled with the drug name and date.
Intravenous aminoglycosides can be given with penicillins and cephalosporins but should not be mixed in the same container. The IV line should be flushed between antibiotics, or separate tubing sets may be set up. Gentamicin must be infused over 30 to 60 minutes. It is not necessary to measure ampicillin peak and trough levels. Giving the drugs at the same time increases the risk of mixing them together.
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17. The nurse is reviewing a patient’s chart prior to administering gentamycin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the nurse take?
a. Administer the next dose as ordered.
b. Obtain repeat peak and trough levels before giving the next dose.
c. Report possible drug toxicity to the patient’s provider.
d. Report a decreased drug therapeutic level to the patient’s provider.
ANS: C
c. Report possible drug toxicity to the patient’s provider.
Gentamycin peak values should be 5 to 8 mcg/mL, and trough levels should be 0.5 to 2 mcg/mL. Peak levels give information about whether or not a drug is at toxic levels, while trough levels indicate whether a therapeutic level is maintained. This drug is at a toxic level, and the next dose should not be given.
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18. The nurse is providing discharge teaching for a patient who will receive oral levofloxacin (Levaquin) to treat pneumonia. The patient takes an oral hypoglycemic medication and uses over-the-counter (OTC) antacids to treat occasional heartburn. The patient reports frequent arthritis pain and takes acetaminophen when needed. Which statement by the nurse is correct when teaching this patient?
a. “You may take antacids with levofloxacin to decrease gastrointestinal upset.”
b. “You may take nonsteroidal anti-inflammatory medications (NSAIDs) for arthritis pain.”
c. “You should monitor your serum glucose more closely while taking levofloxacin.”
d. “You should take levofloxacin on an empty stomach to improve absorption.”
ANS: C
c. “You should monitor your serum glucose more closely while taking levofloxacin.”
Levofloxacin may increase the effects of oral hypoglycemic medications, so patients taking these should be advised to monitor their serum glucose levels closely. Antacids decrease the absorption of levofloxacin. NSAIDs taken with levofloxacin can cause central nervous system reactions, including seizures.
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1. Which is a characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infection?
a. Sulfonamides are bactericidal.
b. Sulfonamides are derived from biologic substances.
c. Sulfonamides have antifungal and antiviral properties.
d. Sulfonamides increase bacterial synthesis of folic acid.
ANS: B
b. Sulfonamides are derived from biologic substances.
Sulfonamides are bacteriostatic, not bactericidal. They are not derived from biologic substances. They are not antifungals or antivirals. They act by decreasing bacterial synthesis of folic acid.
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2. The nurse is counseling a patient who will begin taking a sulfonamide drug to treat a urinary tract infection. What information will the nurse include in teaching?
a. “Drink several quarts of water daily.”
b. “If stomach upset occurs, take an antacid.”
c. “Limit sun exposure to no more than 1 hour each day.”
d. “Sore throat is a common, harmless side effect.”
ANS: A
a. “Drink several quarts of water daily.”
Patients should drink several quarts of water daily while taking sulfonamides to prevent crystalluria. Patients should not take antacids with sulfonamides. Patients should not go out into the sun. Sore throat should be reported.
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3. A female patient who is taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) to treat a urinary tract infection reports vaginal itching and discharge. The nurse will perform which action?
a. Ask the patient if she might be pregnant.
b. Reassure the patient that this is a normal side effect.
c. Report a possible superinfection to the provider.
d. Suspect that the patient is having a hematologic reaction.
ANS: C
c. Report a possible superinfection to the provider.
Superinfection can occur with a secondary infection. Vaginal itching and discharge is a sign of superinfection. This is not symptomatic of pregnancy. These are not common side effects and do not indicate a hematologic reaction.
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4. A patient who will begin taking trimethoprim-sulfamethoxazole (TMP-SMX) asks the nurse why the combination drug is necessary. The nurse will explain that the combination is used to
a. broaden the antibacterial spectrum.
b. decrease bacterial resistance.
c. improve the taste.
d. minimize toxic effects.
ANS: B
b. decrease bacterial resistance.
The combination drug is used to decrease bacterial resistance to sulfonamides. It does not broaden the spectrum, improve the taste, or decrease toxicity.
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5. The nurse is preparing to administer trimethoprim-sulfamethoxazole (TMP-SMX) to a patient who is being treated for a urinary tract infection. The nurse learns that the patient has type 2 diabetes mellitus and takes a sulfonylurea oral antidiabetic drug. The nurse will monitor this patient closely for which effect?
a. Headaches
b. Hypertension
c. Hypoglycemia
d. Superinfection
ANS: C
c. Hypoglycemia
Taking oral antidiabetic agents (sulfonylurea) with sulfonamides increases the hypoglycemic effect. Sulfonylureas do not increase the incidence of headaches, hypertension, or superinfection when taken with sulfonamides. Examples of antidiabetic sulfonylurea medications are glipizide, glimepride, glyburide, tolaamide, and tolbutamide.
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6. The nurse is preparing to give a dose of trimethoprim-sulfamethoxazole (TMP-SMX) and learns that the patient takes warfarin (Coumadin). The nurse will request an order for
a. a decreased dose of TMP-SMX.
b. a different antibiotic.
c. an increased dose of warfarin.
d. coagulation studies.
ANS: D
d. coagulation studies.
Sulfonamides can increase the anticoagulant effects of warfarin. The nurse should request INR levels. An increased dose of warfarin would likely lead to toxicity and to undesirable anticoagulation.
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7. A patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX) calls to report developing an all-over rash. The nurse will instruct the patient to perform which action?
a. Increase fluid intake.
b. Take diphenhydramine.
c. Stop taking TMP-SMX immediately.
d. Continue taking the medication.
ANS: C
c. Stop taking TMP-SMX immediately.
A rash can indicate a serious drug reaction. Patients should stop taking the drug immediately and notify the provider.
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8. The nurse is caring for a patient who is receiving sulfadiazine. The nurse knows that this patient’s daily fluid intake should be at least which amount?
a. 1000 mL/day
b. 1200 mL/day
c. 2000 mL/day
d. 2400 mL/day
ANS: C
c. 2000 mL/day
To prevent crystalluria, patients should consume at least 2000 mL/day.
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9. A patient taking trimethoprim-sulfamethoxazole (TMP-SMX) to treat a urinary tract infection complains of a sore throat. The nurse will contact the provider to request an order for which laboratory test(s)?
a. Complete blood count with differential
b. Throat culture
c. Urinalysis
d. Coagulation studies
ANS: A
a. Complete blood count with differential
A sore throat can indicate a life-threatening anemia, so a complete blood count with differential should be ordered.
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10. The nurse is caring for a patient who is ordered to receive PO trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 QID to treat a urinary tract infection caused by E. coli. The nurse will contact the provider to clarify the correct
a. dose.
b. drug.
c. frequency.
d. route.
ANS: C
c. frequency.
TMP-SMX is taken twice daily. This is the correct dose, drug, and route to treat this condition.
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11. The nurse is preparing to give trimethoprim-sulfamethoxazole (TMP-SMX) to a patient and notes a petechial rash on the patient’s extremities. The nurse will perform which action?
a. Hold the dose and notify the provider.
b. Request an order for a blood glucose level.
c. Request an order for a BUN and creatinine level.
d. Request an order for diphenhydramine (Benadryl).
ANS: A
a. Hold the dose and notify the provider.
A petechial rash can indicate a severe adverse reaction and should be reported.
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12. The nurse is caring for a patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX). The nurse learns that the patient takes an angiotension-converting enzyme (ACE) inhibitor. To monitor for drug interactions, the nurse will request an order for which laboratory test(s)?
a. A complete blood count
b. BUN and creatinine
c. Electrolytes
d. Glucose
ANS: C
c. Electrolytes
TMP-SMX can result in hyperkalemia when taken with an ACE inhibitor.
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13. A child who weighs 10 kg will begin taking oral trimethoprim-sulfamethoxazole (TMP-SMX). The liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL. The nurse determines that the child’s dose should be 8 mg of TMP and 40 mg of SMX/kg/day divided into two doses. Which order for this child is correct?
a. 5 mL PO BID
b. 5 mL PO daily
c. 10 mL PO BID
d. 10 mL PO daily
ANS: A
a. 5 mL PO BID
This child should receive (10 kg/8 mg) 80 mg of TMP and (10 kg ´ 40 mg) 400 mL of SMX per day. When divided into two doses, the correct dose is 40 mg TMP and 200 mg SMX, or 5 mL per dose.
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14. Which is a characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infection?
a. Sulfonamides are bactericidal.
b. Sulfonamides are derived from biologic substances.
c. Sulfonamides have antifungal and antiviral properties.
d. Sulfonamides increase bacterial synthesis of folic acid
ANS: B
b. Sulfonamides are derived from biologic substances.
Sulfonamides are bacteriostatic, not bactericidal. They are not derived from biologic substances. They are not antifungals or antivirals. They act by decreasing bacterial synthesis of folic acid.
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1. Which person should be treated with prophylactic antitubercular medication?
a. A child who attends the same school with a child who has tuberculosis
b. A nurse who is working in a hospital
c. An individual who is HIV-positive with a negative TB skin test
d. A patient who has close contact with someone who has tuberculosis
ANS: D
d. A patient who has close contact with someone who has tuberculosis
Personal contact with a person having a diagnosis of tuberculosis is required to indicate prophylactic treatment with antitubercular therapy. Attending the same school does not necessarily mean close contact occurs. Health care professionals do not need prophylactic treatment. HIV-positive individuals with negative TB skin tests do not need prophylaxis.
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2. A patient who has chronic liver disease reports contact with a person who has tuberculosis (TB). The nurse will counsel this patient to contact the provider to discuss
a. a chest x-ray.
b. a TB skin test.
c. liver function tests (LFTs).
d. prophylactic antitubercular drugs.
ANS: B
b. a TB skin test.
Patients who have exposure to TB should have a TB skin test. A chest x-ray is performed if the skin test is positive. LFTs do not need to be done simply because of TB exposure. This patient is not a candidate for antitubercular drug prophylaxis.
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3. A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multi-drug therapy is used to reduce the likelihood of
a. disease relapse.
b. drug hypersensitivity reactions.
c. drug resistance.
d. drug adverse effects
ANS: C
c. drug resistance
Without multi-drug therapy, patients easily develop resistance to antitubercular drugs. Using more than one antitubercular drug does not prevent relapse, hypersensitivity reactions, or adverse effects.
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4. A patient is being treated with isoniazid (INH), rifampin, and pyrazinamide in phase I of treatment for tuberculosis. The organism develops resistance to isoniazid. Which drug will the nurse anticipate the provider will order to replace the isoniazid?
a. Ciprofloxacin (Cipro)
b. Ethambutol (Myambutol)
c. Kanamycin
d. Streptomycin sulfate
ANS: B
b. Ethambutol (Myambutol)
If there is bacterial resistance to isoniazid, the first phase may be changed to ethambutol, rifampin, and pyrazinamide. Ciprofloxacin, kanamycin, and streptomycin are not generally first-line antitubercular drugs.
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5. The nurse is caring for a patient who is diagnosed with tuberculosis. The patient tells the nurse that the provider plans to order a prophylactic antitubercular drug for family members and asks which drug will be ordered. The nurse will expect the provider to order which drug?
a. Isoniazid (INH)
b. Pyrazinamide
c. Rifampin (Rifadin)
d. Streptomycin
ANS: A
a. Isoniazid (INH)
INH is the drug of choice for prophylactic treatment of patients who have had close contact with a patient who has tuberculosis.
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6. The nurse caring for a patient who has tuberculosis and who is taking isoniazid, rifampin, and streptomycin reviews the medical record and notes the patient’s sputum cultures reveal resistance to streptomycin. The nurse will anticipate that the provider will take which action?
a. Add ethambutol (Myambutol).
b. Change the streptomycin to clarithromycin.
c. Change the streptomycin to kanamycin.
d. Order renal function tests.
ANS: C
c. Change the streptomycin to kanamycin.
The patient’s current regimen is first-phase treatment. If resistance to streptomycin develops, the provider can change to kanamycin or to ciprofloxacin. Ethambutol is added if there is resistance to isoniazid. Clarithromycin is used during phase II. Renal function tests are not indicated.
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7. A patient who is taking isoniazid (INH) as part of a two-drug tuberculosis treatment regimen reports tingling of the fingers and toes. The nurse will recommend discussing which treatment with the provider?
a. Adding pyrazinamide
b. Changing to ethambutol
c. Increasing oral fluid intake
d. Taking pyridoxine (B6)
ANS: D
d. Taking pyridoxine (B6)
Peripheral neuropathy is an adverse reaction to INH, so pyridoxine is usually given to prevent this. It is not necessary to change medications. Increasing fluids will not help with this.
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8. The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching?
a. “I should not wear soft contact lenses while taking rifampin.”
b. “I will need regular eye examinations while taking this drug.”
c. “I will report orange urine to my provider immediately.”
d. “I understand that renal toxicity is a common adverse effect.”
ANS: A
a. “I should not wear soft contact lenses while taking rifampin.”
Patients taking rifampin should be warned that urine, feces, saliva, sputum, sweat, and tears may turn a harmless red-orange color. Patients should not wear soft contact lenses to avoid permanent staining. Regular eye exams are necessary for patients who receive isoniazid and ethambutol. Orange urine is a harmless side effect and does not need to be reported. Renal toxicity is not common with rifampin.
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9. A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid-bacilli test. The nurse will tell the patient that
a. drug resistance has probably occurred.
b. it may be another month before this test is negative.
c. the provider will change the pyrazinamide to ethambutol.
d. there may be a need to remain in the first phase of therapy for several weeks.
ANS: B
b. it may be another month before this test is negative.
The goal is for the patient’s sputum test to be negative 2 to 3 months after the therapy. The positive test does not indicate drug resistance. The provider will not change the drugs or keep the patient in the first phase longer than planned.
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10. The nurse is teaching a nursing student about the antifungal drug amphotericin B. Which statement by the student indicates a need for further teaching?
a. “Amphotericin B may be given intravenously or by mouth.”
b. “Patients who take this drug should have potassium and magnesium levels assessed.”
c. “Patients with renal disease should not take amphotericin B.”
d. “This drug is used for severe systemic infections.”
ANS: A
a. “Amphotericin B may be given intravenously or by mouth.”
Amphotericin B is not absorbed from the gastrointestinal tract, so is not given by mouth. It can cause nephrotoxicity and electrolyte imbalance. It is highly toxic and is reserved for severe, systemic infections.
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11. A patient who has oral candidiasis will begin using nystatin suspension to treat the infection. What information will the nurse include when teaching this patient?
a. “Coat the buccal mucosa with the drug and then rinse your mouth.”
b. “Gargle with the nystatin and then spit it out without swallowing.”
c. “Mix the suspension with 4 ounces of water and then drink it.”
d. “Swish the liquid in your mouth and then swallow after a few minutes.”
ANS: D
d. “Swish the liquid in your mouth and then swallow after a few minutes.”
Patients should be taught to swish the suspension in the mouth to coat the tongue and buccal mucosa and then swallow the medication. It should not be spit out, diluted with water, or swallowed with water.
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12. A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patient’s medical record?
a. Complete blood count (CBC) with differential white cell count
b. Blood urea nitrogen (BUN) and creatinine
c. Potassium and magnesium levels
d. Serum fasting glucose
ANS: B
b. Blood urea nitrogen (BUN) and creatinine
Streptomycin can cause significant renal toxicity.
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13. The nurse is preparing to administer an intravenous polymyxin antibiotic. The patient reports dizziness along with numbness and tingling of the hands and feet. The nurse will perform which action?
a. Administer the drug since these are harmless side effects.
b. Hold the drug and notify the provider of these adverse reactions.
c. Obtain an order for an oral form of this medication.
d. Request an order for serum electrolytes.
ANS: B
b. Hold the drug and notify the provider of these adverse reactions.
Polymyxins can cause nephrotoxicity and neurotoxicity. This patient has signs of neurotoxicity, so the nurse should notify the provider. These effects are generally reversible when the drug is discontinued. It is not correct to administer the drug when these symptoms are present. Polymyxins are not absorbed orally. Serum electrolytes are not indicated.
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14. A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next?
a. Ask about alcohol consumption.
b. Reassure her that these are harmless side effects.
c. Tell her that this signals a worsening of her infection.
d. Tell her to go to the emergency department immediately.
ANS: A
a. Ask about alcohol consumption.
Patients who are taking metronidazole can experience a disulfiram-like reaction when they drink alcohol. These are not harmless adverse effects or a sign of worsening of her infection.
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15. A patient who is taking metronidazole (Flagyl) reports reddish-brown urine. Which action will the nurse take?
a. Obtain an order for BUN and creatinine levels.
b. Reassure the patient that this is a harmless effect.
c. Request an order for a urinalysis.
d. Test her urine for occult blood.
ANS: B
b. Reassure the patient that this is a harmless effect.
Reddish-brown urine is a harmless side effect of metronidazole and is not cause for concern.
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16. A patient is diagnosed with histoplasmosis and will begin taking ketoconazole. What information will the nurse include when teaching this patient about this medication?
a. “Take the medicine twice daily.”
b. “Take the medication with food.”
c. “You may consume small amounts of alcohol.”
d. “You will not need lab tests while taking this drug.”
ANS: B
b. “Take the medication with food.”
Ketoconazole should be taken with food. It is administered once daily. Patients taking antifungals should not consume alcohol. Antifungals can cause liver and renal toxicity, so patients will need lab monitoring.
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17. A patient who has AIDS is at risk to contract aspergillosis. The nurse will anticipate that which antifungal medication will be ordered prophylactically for this patient?
a. Metronidazole (Flagyl)
b. Micafungin (Mycamine)
c. Posaconazole (Noxafil)
d. Voriconazole (Vfend)
ANS: C
c. Posaconazole (Noxafil)
Posaconazole is given for prophylactic treatment of Aspergillus and Candida infections
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18. A patient is diagnosed with tinea capitis. The provider will order which systemic antifungal medication for this patient?
a. Anidulafungin (Eraxis)
b. Fluconazole (Diflucan)
c. Griseofulvin (Fulvicin)
d. Ketoconazole (Nizoral)
ANS: C
c. Griseofulvin (Fulvicin)
Griseofulvin is used to treat tinea capitis. Anidulafungin is used to treat esophageal candidiasis, candidemia, and other Candida infections. Fluconazole is used to treat Candida infections and cryptococcal meningitis. Ketoconazole is used to treat Candida infections, histoplasmosis, blastomycosis, and other infections.
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19. Which topical antifungal medication is used to treat vaginal candidiasis?
a. Haloprogin (Halotex)
b. Miconazole (Monistat)
c. Oxiconazole (Oxistat)
d. Terbenafine HCl (Lamisil)
ANS: B
b. Miconazole (Monistat)
Topical miconazole is used to treat vaginal candidiasis.
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20. A patient who takes an oral sulfonylurea medication will begin taking fluconazole (Diflucan). The nurse will expect to monitor which lab values in this patient?
a. Blood urea nitrogen (BUN) and creatinine
b. Electrolytes
c. Fluconazole levels
d. Glucose
ANS: D
d. Glucose
Patients taking sulfonylurea drugs may have altered serum glucose when taking antifungal medications.
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1. A client is being treated for tuberculosis. Which medications are used to treat this condition? (Select all that apply.)
a. Streptomycin sulfate
b. Amoxicillin (Amoxil)
c. Ethambutol (Myambutol)
d. Gentamicin (Garamycin)
e. Rifabutin (Mycobutin)
f. Ethionamide (Trecator-SC)
g. Pyrazinamide
ANS: A, C, E, F, G
a. Streptomycin sulfate
c. Ethambutol (Myambutol)
e. Rifabutin (Mycobutin)
f. Ethionamide (Trecator-SC)
g. Pyrazinamide
Streptomycin sulfate, ethambutol (Myambutol), rifabutin (Mycobutin), ethionamide (Trecator-SC), and pyrazinamide are used to treat tuberculosis. The other medications are not used.
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1. A patient calls the clinic in November to report a temperature of 103° F, headache, a nonproductive cough, and muscle aches. The patient reports feeling well earlier that day. The nurse will schedule the patient to see the provider and will expect the provider to order which medication?
a. Amantadine HCl (Symmetrel)
b. Influenza vaccine
c. Rimantadine HCl (Flumadine)
d. An over-the-counter drug for symptomatic treatment
ANS: C
c. Rimantadine HCl (Flumadine)
Rimantadine is used for treatment of influenza. Amantadine is used primarily for prophylaxis, and this patient already has symptoms. The influenza vaccine may be given later to protect against other strains. Over-the-counter medications may be used as adjunct treatment.
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2. A nurse whose last flu vaccine was 1 year prior is exposed to the influenza A virus. The occupational health nurse will administer which medication?
a. Acyclovir (Zovirax)
b. Amantadine HCl (Symmetrel)
c. Influenza vaccine
d. Oseltamivir phosphate (Tamiflu)
ANS: B
b. Amantadine HCl (Symmetrel)
The primary use for amantadine is prophylaxis against influenza A. Acyclovir is used to treat herpes virus. Oseltamivir phosphate (Tamiflu) is to be taken once flu symptoms appear.
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. A patient is diagnosed with influenza and will begin taking a neuraminidase inhibitor. The nurse knows that this drug is effective when taken within how many hours of onset of flu symptoms?
a. 12 hours
b. 24 hours
c. 48 hours
d. 72 hours
ANS: C
c. 48 hours
Neuraminidase inhibitors, such as zanamivir and oseltamivir, should be taken within 48 hours of onset of symptoms for best effect.
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4. The nurse receives an order to administer a purine nucleoside antiviral medication. The nurse understands that this medication treats which type of virus?
a. Hepatitis virus
b. Herpes virus
c. HIV
d. Influenza virus
ANS: B
b. Herpes virus
Purine nucleosides, such as acyclovir, are used to treat herpes simplex viruses 1 and 2, herpes zoster virus, varicella-zoster virus, and cytomegalovirus.
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5. The nurse is caring for an infant who has respiratory syncytial virus (RSV) and who will receive ribavirin. The nurse expects to administer this drug by which route?
a. Inhalation
b. Intramuscular
c. Intravenous
d. Oral
ANS: A
a. Inhalation
Ribavirin is given by inhalation to treat RSV. Oral ribavirin is used to treat hepatitis C, and intravenous ribavirin is used to treat hepatitis C and Lassa fever
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6. The nurse receives the following order for a patient who is diagnosed with herpes zoster virus: PO acyclovir (Zovirax) 400 mg TID for 7 to 10 days. The nurse will contact the provider to clarify which part of the order?
a. Dose and frequency
b. Frequency and duration
c. Drug and dose
d. Drug and duration
ANS: A
a. Dose and frequency
Acyclovir is used for herpes zoster, but the dose should be 800 mg 5 times daily for 7 to 10 days. The nurse should clarify the dose and frequency. For herpes simplex, 400 mg 3 times daily is correct.
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7. The nurse is teaching a patient who will receive acyclovir for a herpes virus infection. What information will the nurse include when teaching this patient?
a. Blood cell counts should be monitored closely.
b. Dizziness and confusion are harmless side effects.
c. Increase fluid intake while taking this medication.
d. Side effects are rare with this medication.
ANS: C
c. Increase fluid intake while taking this medication.
Patients taking acyclovir should increase fluid intake to maintain hydration. A complete blood count is not required. Dizziness and confusion should be reported to the provider. Antiviral medications have many side effects.
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8. A patient who has travelled to an area with prevalent malaria has chills, fever, and diaphoresis. The nurse recognizes this as which phase of malarial infection?
a. Erythrocytic phase
b. Incubation phase
c. Prodromal phase
d. Tissue phase
ANS: A
a. Erythrocytic phase
The erythrocytic phase of malarial infection occurs when the parasite invades the red blood cells and is characterized by chills, fever, and sweating.
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9. A patient is preparing to travel to a country with prevalent malaria. To prevent contracting the disease, the provider has ordered chloroquine HCl (Aralen). The nurse will instruct the patient to take this drug according to which schedule?
a. 500 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel
b. 1000 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel
c. 500 mg once followed by 500 mg per dose in 6 hours, 24 hours, and 48 hours
d. 1000 mg once followed by 500 mg per dose in 6 hours, 24 hours, and 48 hours
ANS: A
a. 500 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel
For malaria prophylaxis, chloroquine is given 500 mg/dose weekly for 2 weeks prior to travel and then weekly until 6 to 8 weeks after exposure. The dosing schedule of 1000 mg once, followed by 500 mg in 6, 24, and 48 hours is used to treat acute malaria.
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10. A patient is taking chloroquine (Aralen) to treat acute malaria. Which statement by the patient indicates understanding of this medication?
a. “I should abstain from alcohol while taking this medication.”
b. “I should report urine output less than 1000 mL/day.”
c. “I should report visual changes immediately.”
d. “I should take this drug on an empty stomach.”
ANS: C
c. “I should report visual changes immediately.”
Patients taking chloroquine (Aralen) have a risk of visual injury related to side effects of blurred vision and should report visual changes to the provider. There is no restriction on alcohol. Patient should report urine output of less than 600 mL/day, and patients should take the drug with food.
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11. A patient will take an anthelmintic medication and asks the nurse about side effects. The nurse will tell the patient that anthelmintic drugs
a. can cause hepatic toxicity.
b. cause orthostatic hypotension.
c. commonly have gastrointestinal (GI) side effects.
d. have many serious adverse reactions.
ANS: C
c. commonly have gastrointestinal (GI) side effects.
Anthelmintic drugs have many GI side effects, including anorexia, nausea, vomiting, diarrhea, and cramps. Adverse reactions do not occur frequently.
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12. A child is being treated for pinworms, and the parent asks the nurse how to prevent spreading this to other family members. What will the nurse tell the parent?
a. “Give your child baths every day.”
b. “Obtain a daily stool specimen from your child.”
c. “Wash your child’s clothing in hot water.”
d. “Your child should wash hands well after using the toilet.”
ANS: D
d. “Your child should wash hands well after using the toilet.”
To prevent the spread of pinworms, good hand washing after toileting is recommended. Patients should take showers, not baths. It is not necessary to get regular stool specimens or to wash clothing in hot water.
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13. A patient who is taking acyclovir (Zovirax) to treat an oral HSV-1 infection asks the nurse why oral care is so important. The nurse will tell the patient that meticulous oral care helps to
a. minimize transmission of disease.
b. prevent gingival hyperplasia.
c. reduce viral resistance to the drug.
d. shorten the duration of drug therapy
ANS: B
b. prevent gingival hyperplasia.
Good oral care can prevent gingival hyperplasia in patients with HSV-1.
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14. A child is diagnosed with pinworms. Which anthelmintic drug will the provider order for this child?
a. Bithionol (Bitin)
b. Diethylcarbamazine (Hetrazan)
c. Mebendazole (Vermox)
d. Praziquantel (Biltricide)
ANS: C
c. Mebendazole (Vermox)
Mebendazole is used to treat pinworms. The other drugs treat other types of parasites.
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15. The patient has been ordered treatment with rimantadine (Flumadine). The patient has renal impairment. The nurse anticipates what change to the dose of medication?
a. Increased
b. Decreased
c. Unchanged
d. Held
ANS: B
b. Decreased
The dosage of the medication will be decreased when the patient has renal impairment.
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16. The nurse is teaching a patient who is receiving chloroquine (Aralen) for malaria prophylaxis. Which statement by the patient indicates a need for further teaching?
a. “I may experience hair discoloration while taking this drug.”
b. “I should not take this drug with lemon juice.”
c. “I should use sunscreen while taking this drug.”
d. “If I have gastrointestinal upset, I should take an antacid.”
ANS: D
d. “If I have gastrointestinal upset, I should take an antacid.”
Patients should not take these drugs with antacids.
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1. Which diseases are caused by herpes viruses? (Select all that apply.)
a. Chicken pox
b. Hepatitis
c. Influenza
d. Mononucleosis
e. Shingles
ANS: A, D, E
a. Chicken pox
d. Mononucleosis
e. Shingles
Herpes viruses cause chicken pox, mononucleosis, and shingles.
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1. A 25-year-old female patient reports urinary frequency with pain on urination, flank pain, fever, and chills. The nurse recognizes these symptoms as characteristic of which condition?
a. Cystitis
b. Dysuria
c. Pyelonephritis
d. Urethritis
ANS: C
c. Pyelonephritis
These are symptoms of pyelonephritis, characterized by fever, dysuria, flank pain, and urinary frequency.
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2. A male patient reports urinary urgency and pain with burning on urination. The nurse understands that this patient will be treated for which condition?
a. Cystitis
b. Prostatitis
c. Pyelonephritis
d. Urethritis
ANS: B
b. Prostatitis
In a male patient, a lower UTI is most likely prostatitis with symptoms similar to cystitis.
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3. The nurse is caring for a patient who is diagnosed with a urinary tract infection. The patient reports always having difficulty remembering to take medications. Which drug will the nurse expect the provider to select when treating this patient?
a. Fosfomycin tromethamine (Monurol)
b. Nalidixic acid (NegGram)
c. Nitrofurantoin (Macrodantin)
d. Trimethoprim-sulfamethoxazole (Bactrim)
ANS: A
a. Fosfomycin tromethamine (Monurol)
Fosfomycin is given as a one-time, single dose. Nalidixic acid is given 4 times daily for 1 to 2 weeks. Nitrofurantoin is given 4 times daily. Trimethoprim-sulfamethoxazole is given twice daily.
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4. The nurse is caring for a hospitalized patient who has symptoms characteristic of pyelonephritis. Before administering the first dose of the intravenous antibiotic, the nurse will ensure that which action is performed?
a. An antipyretic is administered.
b. A dose of oral antibiotic is given.
c. A urinary analgesic is given.
d. A urine culture is obtained.
ANS: D
d. A urine culture is obtained.
A urinalysis, as well as a culture and sensitivity, is usually performed before initiating drug therapy. An antipyretic is indicated for fever but does not need to be timed before the antibiotic. An oral antibiotic is not indicated. A urinary analgesic is given as needed.
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5. The nurse provides teaching for a patient who will begin taking nitrofurantoin (Macrodantin) to treat a urinary tract infection. Which statement by the patient indicates understanding of the teaching?
a. “If I experience gastrointestinal upset, I may take an antacid.”
b. “I should notify my provider immediately if my urine is brown.”
c. “I should take the drug with food and increase my fluid intake.”
d. “Tingling of my fingers is a harmless side effect of this drug.”
ANS: C
c. “I should take the drug with food and increase my fluid intake.”
Patients taking nitrofurantoin should take the drug with foods and increase fluid intake. The drug should not be taken with antacids. Brown urine is a harmless side effect. Tingling of extremities can indicate neuropathy.
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6. The nurse is preparing to administer methenamine (Hiprex) to a patient who is diagnosed with a urinary tract infection. The nurse reviews the patient’s chart and notes a urinary pH of 6.0. Which action will the nurse take?
a. Administer the drug as ordered.
b. Obtain an order for 8 ounces of cranberry juice 3 times daily.
c. Request an order for an increased dose.
d. Restrict fluids to concentrate the patient’s urine.
ANS: B
b. Obtain an order for 8 ounces of cranberry juice 3 times daily.
Methenamine produces a bactericidal effect when the urine pH is less than 5.5. Cranberry juice will help to acidify the urine.
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7. Which side effects are common to most urinary antiseptics?
a. Dyspnea and chest pain
b. Nausea and vomiting
c. Peripheral neuritis
d. Visual disturbances
ANS: B
b. Nausea and vomiting
Nausea and vomiting are common to most urinary antiseptics.
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8. The nurse is preparing to administer a phenazopyridine HCl (Pyridium) dose to a patient who has diabetes. The nurse notes that the patient has a positive Clinitest. What will the nurse do next?
a. Encourage the patient to increase oral fluid intake.
b. Hold the dose until the patient’s Clinitest is negative.
c. Notify the provider of the patient’s hyperglycemia.
d. Request an order for serum blood glucose.
ANS: D
d. Request an order for serum blood glucose.
Phenazopyridine can alter the glucose urine test (Clinitest), so a blood test should be done to monitor glucose
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9. A patient who has pain with urination associated with cystitis will be discharged home with a prescription for phenazopyridine (Pyridium). What instruction will the nurse include when teaching the patient about this drug?
a. “Do not take this drug concurrently with an antibiotic.”
b. “Report reddish-brown urine to the provider immediately.”
c. “This drug has antiseptic and analgesic properties.”
d. “The drug provides symptomatic relief of pain.”
ANS: D
d. “The drug provides symptomatic relief of pain.”
Phenazopyridine is used to provide symptomatic pain relief. It may be taken with antibiotics. Reddish-brown urine is a harmless side effect. It does not have antiseptic properties.
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10. The nurse is preparing to administer bethanechol chloride (Urecholine) to a patient. The nurse understands that this drug acts to
a. block parasympathetic nerve impulses.
b. increase the tone of the urinary detrusor muscle.
c. relax smooth muscles in the urinary tract.
d. relieve urinary pain and burning.
ANS: B
b. increase the tone of the urinary detrusor muscle
Bethanechol is used to increase the tone of the detrusor muscle and increase bladder tone to stimulate urination. It stimulates the parasympathetic nerves. It tones the smooth muscles of the urinary tract. It does not alleviate dysuria.
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11. An older woman has urgent urinary incontinence related to an overactive bladder. Which medication does the nurse expect the provider to order?
a. Dimethylsulfoxide (DMSO)
b. Flavoxate (Urispas)
c. Phenazopyridine HCl (Pyridium)
d. Tolterodine tartrate (Detrol)
ANS: D
d. Tolterodine tartrate (Detrol)
Detrol is used to treat an overactive bladder. Dimethylsulfoxide (DMSO) and flavoxate (Urispas) are used to relax uterine smooth muscle. Phenazopyridine HCl (Pyridium) is used to alleviate the pain and burning sensation during urination that is experienced with chronic cystitis.
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12. The nurse assumes care for a patient who is experiencing urinary tract spasms and is ordered to receive flavoxate HCl (Urispas). When reviewing this patient’s history, which condition would cause the nurse to notify the provider?
a. Chronic obstructive pulmonary disorder
b. Diabetes
c. Glaucoma
d. Hypotension
ANS: C
c. Glaucoma
Urispas should not be used for patient who has gastrointestinal or urinary tract obstruction or if the patient has glaucoma.
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13. The nurse is preparing to administer methenamine (Hiprex) to a patient who has pyelonephritis. Which action will the nurse perform?
a. Increase fluid intake to 2000 mL per day.
b. Monitor the patient’s urine for dark brown color.
c. Order alkaline foods 3 times daily.
d. Request an order for a sulfonamide antibiotic.
ANS: A
a. Increase fluid intake to 2000 mL per day
Patients who take methenamine can develop crystalluria and should increase fluid intake to prevent this effect. A reddish-brown color is a harmless side effect. Patients should have acidic urine, not alkaline urine. Methenamine taken with sulfonamides increases the risk of crystalluria.
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14. The nurse is teaching a parent about administering nitrofurantoin suspension to a 5-year-old child. Which instruction will the nurse include in the patient teaching?
a. “Give the medication on an empty stomach.”
b. “Have the child rinse the mouth after taking the drug.”
c. “Limit the child’s fluid intake to concentrate the urine.”
d. “Report brownish-colored urine to the child’s provider.”
ANS: B
b. “Have the child rinse the mouth after taking the drug.”
Nitrofurantoin suspension can stain the teeth, so patients should rinse the mouth after taking it. Nitrofurantoin should be taken with food, and patients should increase fluids. A reddish-brown color is a harmless side effect.
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15. A patient will begin taking a urinary antimuscarinic medication. Which symptom should the patient report immediately?
a. Dry mouth
b. Fatigue
c. Increased heart rate
d. Urinary retention
ANS: D
d. Urinary retention
Urinary retention should be reported to the provider. Dry mouth, fatigue, and increased heart rate are side effects, but they do not necessarily warrant reporting immediately. Urinary retention is more serious.
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1. A patient who has cancer is about to begin chemotherapy. The patient asks the nurse why two chemotherapeutic agents are being used instead of just one. Which response by the nurse is correct?
a. “The drugs may be given in less toxic doses if two drugs are used.”
b. “Two agents used together can have synergistic effects.”
c. “Use of two drugs will increase tumorcidal activity in the G0 phase of the cell.”
d. “Using two agents will shorten the length of time chemotherapy is needed.”
ANS: B
b. “Two agents used together can have synergistic effects.”
Using two or more chemotherapeutic agents can have a synergistic effect. Combination therapy typically uses two drugs with different dose-limiting toxicities, but the use of more than one drug does not allow for using less toxic doses. Combination therapy allows cell kill in all phases of the cell cycle. Combination therapy does not shorten the length of time chemotherapy is needed.
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2. A patient who is about to begin chemotherapy asks the nurse when the risk of infection is highest. The nurse will tell the patient that infection risk is greatest at which point?
a. A week to 10 days after each chemotherapy dose
b. During the week immediately after chemotherapy
c. Immediately prior to each dose of chemotherapy
d. When the patient’s temperature is elevated by 1° F
ANS: A
a. A week to 10 days after each chemotherapy dose
Following chemotherapy administration, the time at which the blood count, including white blood cells, is lowest is typically 7 to 10 days after treatment.
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3. The nurse is caring for a patient who is receiving a third dose of high-dose cyclophosphamide (Cytoxan). The nurse notes hematuria. The nurse will notify the provider and will perform which action?
a. Ask whether the patient takes allopurinol (Lopurin).
b. Assess the patient’s skin and fingernails for darkening.
c. Question the patient about fluid intake.
d. Reassure the patient that this is an expected side effect.
ANS: C
c. Question the patient about fluid intake.
Hemorrhagic cystitis is a common adverse effect of high-dose cyclophosphamide and can be mitigated by increasing fluid intake. Allopurinol is given to treat gout, which is characterized by uric acid crystalluria. Darkening of the fingernails and skin is a common adverse effect of cyclophosphamide but is unrelated to hemorrhagic cystitis.
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4. The nurse is caring for a patient who is receiving intravenous mechlorethamine (Mustargen). The patient reports pain at the IV site, and the nurse assesses swelling and pallor at the site. What action will the nurse take?
a. Administer an analgesic medication.
b. Apply a warm compress to the site.
c. Slow the infusion and notify the provider.
d. Stop the infusion immediately.
ANS: D
d. Stop the infusion immediately.
Methchlorethamine is a severe vesicant and can cause tissue necrosis if it infiltrates into the tissues. The nurse should stop the infusion.
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5. An oncology home care nurse is preparing to administer a chemotherapeutic agent to a patient at the patient’s home. What precautions will the nurse take while administering the IV chemotherapeutic agent?
a. Clear a counter space for preparation of the solution.
b. Don a surgical mask while administering the drug.
c. Take surgical scrubs to wear during the infusion.
d. Wear an impermeable, disposable gown when hanging the drug.
ANS: D
d. Wear an impermeable, disposable gown when hanging the drug.
Nurses should take precautions when handling cytotoxic drugs if inhalation, ingestion, or contact with skin and mucous membranes is possible. When hanging an IV solution, it is possible to splash solution onto the skin, so the nurse should wear a disposable, impermeable gown. If the nurse has to prepare a solution at home, a plastic-backed pad should be used as a surface. When there is a risk of aerosol exposure, a National Institute for Occupational Safety and Health–approved respirator is necessary. Surgical masks do not provide adequate respiratory protection. Surgical scrubs are permeable.
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6. The nurse is teaching a patient who will take oral cyclophosphamide (Cytoxan). Which statement by the patient indicates understanding of the teaching?
a. “I should follow a diet high in organ meats and beans while taking this drug.”
b. “I should brush my teeth and gums vigorously twice daily.”
c. “I should report any low-grade temperature elevation immediately.”
d. “I should take the drug at bedtime to minimize side effects.”
ANS: C
c. “I should report any low-grade temperature elevation immediately.”
Even a low-grade temperature should be reported because it can indicate significant infection in immunocompromised patients. Patients should eat a low-purine diet while taking this medication. Patients should brush teeth and gums with a soft bristle toothbrush. Patients should take the medication early in the day to avoid accumulation in the bladder.
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7. A patient is receiving bleomycin (Blenoxane) as part of a chemotherapeutic regimen to treat leukemia. During intravenous administration of this drug, what will the nurse observe the patient closely for?
a. Hypotension and visual disturbances
b. Pain and blistering at the IV site
c. Pink to red urine
d. Shortness of breath and wheezing
ANS: D
d. Shortness of breath and wheezing
Bleomycin can cause anaphylaxis, so patients should be monitored for respiratory distress. Pain and blistering at the IV site is common to antitumor antibiotics except for bleomycin. Urine color changes occur with doxorubicin. Vincristine causes hypotension and visual disturbances.
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8. A patient is receiving the antitumor antibiotic doxorubicin (Adriamycin) to treat lung cancer. The patient is experiencing shortness of breath and palpitations. The nurse is concerned that the patient has developed which condition?
a. Anemia
b. Cardiotoxicity
c. Hypersensitivity
d. Pulmonary infection
ANS: B
b. Cardiotoxicity
Cardiotoxicity is a known adverse effect of this drug and is manifested in shortness of breath, edema, and palpitations.
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9. The nurse is caring for a patient who is receiving vincristine (Oncovin), a plant alkaloid chemotherapeutic agent, to treat non-Hodgkin’s lymphoma. The nurse observes that the patient has difficulty walking. What action will the nurse take?
a. Ask about numbness or tingling in the fingers and toes.
b. Assess heart rate and blood pressure to evaluate for orthostatic hypotension.
c. Assess the temperature to evaluate for infection.
d. Request an order for a complete blood count and electrolytes.
ANS: A
a. Ask about numbness or tingling in the fingers and toes.
Peripheral neuropathy can occur with this drug and is manifested by difficulty walking and numbness and tingling in the fingers and toes. Orthostatic hypotension is not a side effect. Infection is always a concern, and regular evaluation of complete blood count and electrolytes is performed but not related to signs of peripheral neuropathy.
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10. A woman who has advanced breast cancer will begin receiving androgen therapy. The nurse will explain to the patient that androgen therapy is used to
a. enhance her own estrogen production.
b. give her a sense of well-being.
c. minimize hot flashes.
d. promote regression of her tumor.
ANS: D
d. promote regression of her tumor.
Androgen is used to treat breast cancer to promote regression of tumors. Other hormonal therapies are used in other circumstances to promote well-being.
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11. The nurse is teaching a patient who is receiving vincristine (Oncovin) about long-term management of the treatment regimen. Which information will the nurse provide in teaching the patient?
a. “If you experience numbness of your hands, it will eventually resolve.”
b. “If your IV starts to hurt, you should pull the IV out immediately.”
c. “You should ask for antinausea medication at the first sign of nausea.”
d. “You should report difficulty buttoning your clothes to your provider.”
ANS: D
d. “You should report difficulty buttoning your clothes to your provider.”
Difficulty buttoning clothing is a sign of peripheral neuropathy and should be reported. Numbness of hands may resolve after chemotherapy is stopped, but it may never resolve. If the IV infiltrates, the infusion should be stopped and the needle left in until attempts to aspirate residual vesicant are performed. Antinausea medication should be given prior to beginning the infusion.
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1. The nurse is caring for a patient who is receiving fluorouracil (5-FU) to treat pancreatic cancer. Which interventions are included in the nurse’s plan of care for this patient? (Select all that apply.)
a. Apply ice to the IV site if the patient reports pain.
b. Administer antiemetics when the patient reports nausea.
c. Counsel the patient to use waxed dental floss.
d. Discourage visits with people who have respiratory infections.
e. Offer ice chips frequently.
f. Restrict to nothing by mouth during intravenous drug administration.
ANS: A, C, E
a. Apply ice to the IV site if the patient reports pain.
c. Counsel the patient to use waxed dental floss.
e. Offer ice chips frequently.
If the patient reports pain at the IV site, the nurse should apply ice and notify the provider. Patients should use waxed dental floss to avoid bleeding of the gums. Ice chips help with oral pain. Antiemetics should be given prior to administration of the drug. Visitors with active infections should be restricted. Patients do not need to be NPO during the IV infusion.
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1. The nurse is teaching a patient who will begin receiving targeted therapy for cancer. The patient asks how targeted therapy differs from other types of chemotherapies. The nurse will explain that targeted therapy
a. damages cancer cell DNA to prevent cell replication.
b. directly kills or damages cancerous cells.
c. interferes with specific molecules in cancer cells.
d. prevents metastasis of cancer cells.
ANS: C
c. interferes with specific molecules in cancer cells.
Targeted therapy differs from traditional cancer chemotherapy by taking advantage of biologic features particular to cancer cells and targeting specific mechanisms. They block the growth and spread of cancer by interfering with specific molecules within the cancer cells. Traditional chemotherapeutic agents damage cell DNA of cancer cells as well as normal cells. Targeted therapies do not directly kill or damage cancer cells or prevent metastasis.
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2. A patient who has breast cancer tells the nurse that a cousin who had breast cancer received trastuzamab (Herceptin) and wonders why this drug is not given to her. The nurse will explain that her cancer cells do not have
a. significant HER2 receptors.
b. epidermal growth factor receptor-tyrosine kinase.
c. the BRCA1 suppressor gene.
d. VGEF proteins.
ANS: A
a. significant HER2 receptors.
Trastuzamab acts by binding to the HER2 protein on the surface of cancer cells that overexpress this receptor. If patients do not have this overexpression, this targeted therapy will not work. Gefitinib is used when EGFR-TK are present. Bevacizumab is used when VGEF proteins are present.
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3. The nurse is performing a history on a patient who will begin taking bevacizumab (Avastin). Which aspect of the patient’s history should be reported to the oncologist treating this patient?
a. History of hepatitis
b. Hypertension
c. Recent surgical history
d. Weight loss
ANS: C
c. Recent surgical history
Bevacizumab carries a boxed warning for gastrointestinal perforations, wound dehiscence, impaired wound healing, hemorrhage, and fistula formation after surgery. The drug should not be used within 28 days after major surgery.
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4. The patient asks the nurse what apoptosis means. The nurse will explain that apoptosis refers to
a. alteration of cellular functions.
b. inhibition of cell division.
c. prevention of cell phase progression.
d. slow, planned cellular death.
ANS: D
d. slow, planned cellular death.
Apoptosis is programmed cell death, designed to ensure that tissues contain only healthy and optimally functional cells.
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5. The nurse is preparing to administer intravenous monoclonal antibodies to a patient who has cancer. What is an important nursing action for this patient?
a. Having resuscitation equipment readily available
b. Monitoring the patient’s renal function during the infusion
c. Observing the patient closely for development of a rash
d. Performing careful intake and output
ANS: A
a. Having resuscitation equipment readily available
When administering monoclonal antibodies intravenously, resuscitation equipment should be nearby, and nurses should stay with the patient for the first 15 minutes of the infusion.
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6. The nurse performs a medication history on a patient who will begin targeted therapy for cancer with gefitinib (Iressa). The nurse learns that the patient is taking carbamazepine, a histamine2 blocker, and warfarin. The nurse will anticipate that the provider will make which change to the medication regimen?
a. decrease the gefitinib dose.
b. decrease the warfarin dose.
c. increase the histamine2 blocker dose.
d. increase the carbamazepine dose.
ANS: B
b. decrease the warfarin dose.
When patients taking warfarin take gefitinib, the effectiveness of the warfarin is greatly increased, and bleeding risks increase. Carbamazepine and histamine2 blockers decrease the effectiveness of gefitinib, so decreasing the gefitinib dose or decreasing the carbamazapine or histamine2 blocker is not recommended.
179
7. The nurse is preparing to administer intravenous temsirolimus (Torisel). To prevent a common adverse drug effect, the nurse will expect to administer which type of drug?
a. An antibiotic
b. An anticoagulant
c. An antiemetic
d. An antihistamine
ANS: D
d. An antihistamine
Hypersensitivity reactions to temsirolimus are common, and pretreatment with antihistamines is recommended. Other drugs are given as needed but not prophylactically.
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8. A patient who is taking the tyrosine kinase inhibitor sunitinib (Sutent) calls to report red, painful, and swollen palms and soles of feet. The nurse will perform which action?
a. Notify the patient’s provider of this adverse reaction.
b. Reassure the patient that these are common side effects.
c. Recommend taking acetaminophen for discomfort.
d. Suggest taking diphenhydramine to help with the swelling.
ANS: A
a. Notify the patient’s provider of this adverse reaction.
The nurse should notify the provider if the patient reports these symptoms, since they may indicate erythrodysesthesia. Reassuring the patient or recommending OTC treatments is not indicated.
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9. The nurse is preparing to give a dose of dasatinib (Sprycel) to a patient. The nurse notes that the patient has just completed a meal. The tablet is in the packaging but is broken in two pieces. What is the correct action by the nurse?
a. Administer the medication with an antacid.
b. Return the tablet to the pharmacy.
c. Wait for 2 hours before giving the medication.
d. Wear gloves when handling the tablet.
ANS: D
d. Wear gloves when handling the tablet.
Because the contents of the tablet are toxic, nurse should wear gloves if the tablets are crushed or broken. If patients are taking antacids, the medication should be given 2 hours before or after the antacid. The medication should be given with meals.
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1. A patient is receiving interferon alpha (Roferon-A) subcutaneously. The patient experiences chills, fatigue, and malaise, and the nurse assesses a temperature of 102° F. The nurse will notify the provider of the temperature and will anticipate which order?
a. Administer acetaminophen (Tylenol).
b. Change to intravenous interferon alpha.
c. Give diphenhydramine (Benadryl).
d. Obtain a serum BUN and creatinine level.
ANS: A
a. Administer acetaminophen (Tylenol).
The major side effects of interferon are flulike symptoms with chills, fever, fatigue, malaise, and myalgia. Acetaminophen is given to treat this initially. Changing to an IV form does not alter the side effects. Diphenhydramine is given for nausea caused by interferon alpha. It is not necessary to obtain laboratory work when these symptoms initially occur.
183
2. Prior to administration of interferon alpha, the nurse will administer which medications?
a. Acetaminophen and diphenhydramine
b. Heparin and meperidine
c. Lorazepam and furosemide
d. Narcotic analgesics and loratadine
ANS: A
a. Acetaminophen and diphenhydramine
Patients receiving these drugs should be premedicated with acetaminophen to reduce chills and fever and with diphenhydramine to reduce nausea.
184
3. A patient receiving interferon experiences confusion, somnolence, and aphasia. The nurse will perform which action?
a. Discontinue the medication immediately.
b. Inform the family that these symptoms may persist for years.
c. Reassure the patient that these side effects are reversible.
d. Request an order for lorazepam.
ANS: C
c. Reassure the patient that these side effects are reversible
Neurologic side effects, such as confusion, somnolence, and aphasia, are reversible after the drug is stopped. It is not necessary to stop the medication unless the symptoms progress and become severe. Lorazepam is not indicated.
185
4. The nurse is teaching a young adult patient who will begin receiving interferon. Which statement by the patient indicates understanding of the teaching?
a. “I may have a low-grade fever while taking this medication.”
b. “I may have serious cardiovascular side effects because of this drug.”
c. “I should take antiemetics prior to each dose of this medication.
d. “I may need to avoid people who are sick while I’m taking this drug.”
ANS: C
c. “I should take antiemetics prior to each dose of this medication.
Antiemetics should be given prior to treatment to prevent nausea from occurring. Fevers are common and are usually high. Cardiovascular side effects tend to occur in older patients. Neutropenia is rare with interferon and does not predispose patients to infection.
186
5. A patient who has cancer will begin treatment with a colony-stimulating factor. The patient verbalizes understanding of this drug’s action with which statement?
a. “This drug allows higher doses of chemotherapy.”
b. “This drug has antitumor activity.”
c. “This drug has cytotoxic effects.”
d. “This drug has antiviral effects.”
ANS: A
a. “This drug allows higher doses of chemotherapy.”
Colony-stimulating factors permit the delivery of higher doses of drugs because they counter myelosuppression. They do not have antitumor activity, cytotoxic effects, or antiviral effects.
187
6. A patient is receiving the erythropoietin-stimulating agent epoietin alfa (Procrit). Which assessment finding would cause the nurse to notify the patient’s provider?
a. Blood pressure of 90/65 mm Hg
b. Headache and nausea
c. Hemoglobin > 12 g/dL
d. Infiltration of the IV
ANS: C
c. Hemoglobin > 12 g/dL
There is an increased risk of death and serious cardiovascular events when the hemoglobin is greater than 12 g/dL. There is no need to notify the provider of the other findings.
188
7. A patient who is receiving cancer chemotherapy has been ordered to receive epoetin alfa (Procrit) 150 units/kg 3 times weekly. The nurse reviews the patient’s chart and notes a hemoglobin level of 10.1 g/dL. The nurse will perform which action?
a. Administer the medication as ordered.
b. Hold the dose and notify the provider.
c. Reduce the dose by 25%.
d. Request an order for an increased dose.
ANS: B
b. Hold the dose and notify the provider.
For patients receiving cancer chemotherapy, erythropoietin-stimulating agents should not be initiated at a hemoglobin level greater than or equal to 10 g/dL.
189
8. A patient has been receiving an erythropoietin-stimulating agent (ESA) for 8 weeks. The nurse reviews the patient’s chart and notes no increase in hemoglobin levels from 8 g/dL on week 3 of therapy. The nurse will request an order for
a. a complete blood count and serum iron levels.
b. an increased dose of the erythropoietin-stimulating agent.
c. more frequent dosing of the ESA.
d. packed red blood cell infusions.
ANS: A
a. a complete blood count and serum iron levels
If there is no response, ESAs should be discontinued after 8 weeks of therapy. If a patient does not respond, iron deficiency or underlying hematologic disease should be considered and evaluated.
190
9. A patient is receiving bone marrow transplantation for cancer and receives filgrastim (Neupogen). The patient reports abdominal pain in the left upper quadrant. The nurse will perform which action?
a. Administer acetaminophen 650 mg.
b. Administer an antiemetic medication.
c. Report a potentially life-threatening event.
d. Request an order for cardiac enzyme levels.
ANS: C
c. Report a potentially life-threatening event.
Splenic rupture can occur with this drug and is manifested by pain in the left upper quadrant. The nurse should report the abdominal pain to the provider so the patient can be evaluated for splenic rupture.
191
10. A patient with cancer is receiving pegfilgrastim (Neulasta). The patient reports bone pain, which the nurse recognizes as
a. a sign of cancer metastasis.
b. an indication of expansion of bone marrow.
c. caused by osteomyelitis.
d. worsening neutropenia.
ANS: B
b. an indication of expansion of bone marrow.
Bone pain is common with these drugs and is caused by expansion of the bone marrow. It does not indicate metastasis. The bone pain is not due to osteomyelitis or neutropenia.
192
11. The nurse is preparing to give sargramostim to a patient who has acute myelogenous leukemia (AML). The nurse assesses a heart rate of 78 beats per minute and a blood pressure of 120/70 mm Hg. The patient reports shortness of breath and has a cough and bilateral crackles. What will the nurse do next?
a. Contact the provider; discuss giving a lower dose.
b. Contact the pharmacist; request a bronchodilator.
c. Contact the pharmacist; request an order for furosemide.
d. Contact the provider; suggest administration of antibiotics.
ANS: A
a. Contact the provider; discuss giving a lower dose.
Patients receiving this drug can experience sequestration of granulocytes in the pulmonary circulation and may experience dyspnea. The sargramostim infusion should be reduced in half if this occurs. Bronchospasm, pulmonary edema, and infection are not common side effects.
193
12. The nurse is preparing to administer interleukin-2 to a patient who has cancer. The patient reports shortness of breath. The nurse assesses clear breath sounds, a respiratory rate of 22 breaths per minute, a heart rate of 80 beats per minute, an oxygen saturation of 93% on room air, and a blood pressure of 92/68 mm Hg. The nurse will perform which action?
a. Administer the dose as ordered.
b. Administer oxygen while giving the dose.
c. Discuss permanently discontinuing this treatment with the provider.
d. Hold the dose and notify the provider.
ANS: D
d. Hold the dose and notify the provider.
Because of pulmonary symptoms associated with interleukin-2, the drug should be held if the patient has an oxygen saturation <94% on room air. It may be given when the patient’s oxygen saturation improves. The drug does not need to be permanently discontinued.
194
1. The nurse is evaluating a patient 2 hours after giving a dose of 30 mg of codeine with acetaminophen for postoperative pain after abdominal surgery. The patient reports a pain level of 7 on a scale of 1 to 10. The nurse notes a heart rate of 110 beats per minute, a respiratory rate of 28 breaths per minute, and a blood pressure of 180/90 mm Hg. Which action will the nurse take?
a. Administer the next dose of codeine one hour early.
b. Ask the provider if the codeine dose can be increased.
c. Contact the provider to ask if a dose of ibuprofen may be given now.
d. Request an order for oxycodone with acetaminophen (Percocet).
ANS: D
d. Request an order for oxycodone with acetaminophen (Percocet).
The patient is showing signs of moderate to severe pain unrelieved by codeine, so the nurse should request a more potent opioid analgesic such as oxycodone. Codeine is effective for mild to moderate pain so will not be effective for this patient even if the dose is increased. The medication should not be given more frequently than every 4 hours. Ibuprofen is used for musculoskeletal pain and not postoperative pain.
L2-30
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